HomeMy WebLinkAboutGiglioli, Louis r '
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ELIZABETH A.NEVILLE _*f Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
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REGISTRAR.OF VITAL STATISTICS
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G Southold, New York 11971
Fax (631) 765-6145
MARRIAGE OFFICER y ��
RECORDS MANAGEMENT OFFICER `-��1 �a�•0 Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER �'
OFFICE OF THE TOWN CLERK
SOUTHOLD VASTRIMMEIRIIRSIRDSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 41020-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner GIGLIOLI, LOUIS O.
Mailing Address 1 63 2ND STREET
Mailing Address 2
City St Zip BROOKLYN NY 11231-0000
Property Address 1 1275 BUNGLOW LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 631-298-1034
Tax Map No. section 12.30 block 30 lot 170
Cross Street PARK AVENUE
4.4
Issue Date: 8/22/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICEWN OFSOTOWN
UTHOLD S�,,—.. G Application No. le'
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential C.—
P.O.BOX 1179 ��
SOUTHOLD,NEW YORK 11971 , $25.00 - Non-Residential
Telephone _OI Al
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 7 T/ az'/
OWNER NAME: ,Lott cs 6,;(y_17(31,'
OWNER MAILING ADDRESS: 43 c2 =- ST4 r
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OWNER PROPERTY ADDRESS: 127r 44/y604-0w ,L0g6,-
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OWNER TELEPHONE NUMBER: OW 023 7 - ie/ �� �6 3i) 2Q8-/o iy
TAX MAP NO. : Section 4/3 Block 3 Lot /7
CROSS STREET: /Ate nU6,-7ecccs
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New x 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 buildin• and closest road.)
Signatu a App icant
RECEIVED BY:
�y Town Clerk's Office
DATE: O o� /A-/
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