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HomeMy WebLinkAboutCirincione, Lorin � " •• iii OFFICE OF THE TOWN CLERKS�FFOUrC TOWN OFSOUTHOLD - Application No. �O 9 LIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential P.O.BOX 1179 SOUPHOLD,NEW YORK 11971 �'; $25.00 - Non-Residential Off,• . Telephone 01 ill 'jt% 0' (516) 765-1801 TOWN OF SOUTHOLD R E C E I y E n SOUTHOLD WASTEWATER DISPOSAL DISTRICT,.j , APPLICAT ION Southold Towne for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE 2. 6 do 0 OWNER NAME: Loruv. OWNER MAILING ADDRESS: I9 S;Jubb I« . OWNER PROPERTY ADDRESS: 142l'1 mil (0-4P wrn-rock, 11),(4 r( , c 2- OWNER TELEPHONE NUMBER: (,31) Zo'- i 1 ' ' TAX MAP NO. : Section /Cab Block /07 Lot t/ —2- G CROSS STREET: L) L wn AAR TYPE OF SYSTEM: Septic Tank New V Existing Cesspool New Existing Residential t/' Non-Residential LOCATION MAP: Must be attached hereto before permit may be issued. (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) Signat re pplicant RECEIVED BY: D�- Town Clerk's 0 e DATE: /h4,7 • .1 ,... —. • . - IIe ' -" ‘-;;;...i‘;',.; ,„'; „?.lif:-;;; ;,. ,,*,;...;.,,, V • • . , .;, ,,. ;.- 4.,:.-.0v.:...;;;;--';'7-'4,-X.''-,":•'S; 4 .... -',-*--,-..,:',,.. ,.--t .... . 40" • . , . .-- ,:_--.: ' , --. ::Tr: . ' - • , .-, - . s . . .- ' **,:•'' :'' ..: - . I'. ,s :.:•. .- .,-. .„,-‘,. .r, , r.s,, , -•::-.--,*,1'1,4 '*- \ 4 - "It . . . • . , • . . , - „ . . .. •, 1, . „ . . ,. 4)1:11 '.. 11.1 . • CD. •0:. 4-s , . . - .es. - _4 dr" .• -1:0.1 . • , - , \ - if ‘'•ifil'Al,._ , , ....... ., 1 y \ \ 0 ; 4-;4,2 % .•., , 4, 1 • I, \ 1 iv .„...434. -41i,:. . -: -3 I • 4 ' f?!.:'. ...'; I v) , -o. 4•,_.,,j,. .- oØ ; od 9 ..., C-1!)-.‘..•• 4, . 46tot. 4240) to.- 14,.- , • Q.,,to,cp , • ....da w6'. •:%:`,'" -- .......... ................. -............ \ $33 ---",------ .„ • -,. :,-7.7`•• • .. ,•,,--,., . , --. \ . \ • ,• ,• \ 1 • . :-.,-,..-4;....: . ,. ., . , • \ . , J, ;-"• \ - . i S ...; •... .,,••,. .. 1 -;,,., . • ,,_. v , i • 4,-; I l.9 " ....'!;'•-i;;,;-r;. ; J.) ;-.•.. .- 0 ' ,.':•-5";-; .•, ••":""• % ) ..`1_,..:-. _•;,..,,L 7, ..-",_"i