HomeMy WebLinkAboutVaccari, Lawrence _ >E
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ELIZABETH A. NEVILLE /=�0 co
Town Hall, 53095 Main Road
TOWN CLERK O P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Al �� Southold, New York 11971
MARRIAGE OFFICER * �`F1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = '/Ol *a�'��� Telephone (631) 765-1800
41
FREEDOM OF INFORMATION OFFICER - /9"
OFFICE OF THE TOWN CLERK
SOUTHOLD tOSTRIMATERTVISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4087-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner VACCARI, LAWRENCE
Mailing Address 1 POB 225
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 2470 WELLS ROAD
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 631-734-2558
Tax Map No. section 860.00 block 100 lot 10.001
Cross Street ROUTE 25
144dreti
Issue Date: 1/01/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD O�C��FF�(/�' ,OG Appliiration No. /o 7
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residntia I t�
P.O.BOX 1179
SOUTHOLD,NEWYORK 11971 .*:$ $25.00 - Non-f�esidential
Telephone .01 * 0\70/
70
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 61 , 1 0 \
OWNER NAME: LQW(QJ Ce, C1M1)IJ. VPtC_CAR.1
OWNER MAILING ADDRESS: Po eyo �p�s
uu1t kO G 06 � N y it q 35
OWNER PROPERTY ADDRESS: 4,741O UQ.,IIs Rd
Peirwcy Ny tci 58
OWNER TELEPHONE NUMBER: 3 C) 7 3 - o2558
TAX MAP NO. : Section 1000 Block $(p - Lot (4 . to
CROSS STREET: IweAlS
1oo0
TYPE OF SYSTEM: Septic Tank Pn,ca,s#- New V Existing
Cesspool New ✓ Existing
Residential 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.)
A�fiCA'��
Sig ature of App icant
RECEIVED BY:
Town Clerk's Office
DATE: C(1 /(71/