HomeMy WebLinkAboutIacono a ; wTown Hall, 53095 Main Road
P.O. Box 1179
O ®��r'� Southold, New York 11971
JUDITH T.TERRY �s' I!��� FAX(516)765-1823
TOWN CLERK -''%%%���� TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1402-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner IACONO, LOUIS P.
Mailing Address 1 110 WASHINGTON AVENUE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 110 WASHINGTON AVENUE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1891
Tax Map No. section 41.00 block 1 lot 31 .000
Cross Street BOOTH PLACE
Date Of Last Pump Out 0/00/00
Issue Date: 3/05/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK OFOUr = '_
Town of Southold � CQ ' Application No. 14116
Judith T. Terry, Town Clerk " „s y
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 u' V•!‘ 16.044
r.4�� s rhi $25.00 - Non-Residential
Southold, New York 11971 O .=W;r
Telephone : j
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE , —
OWNER NAME: I, � , / 5 7', f G6
OWNER MAILING ADDRESS: I/O W4-sf};ivc l ,
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OWNER PROPERTY ADDRESS: / H ,7
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C3F ,6//1( t/ ?
OWNER TELEPHONE NUMBER: /26 4/ ,/7 7 --7FF
TAX MAP NO. : Section 9/ Block / Lot 8i
CROSS STREET: ,(3%D72 P/,-c e.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool /i New Existing I.-
Residential j Non-Residential
DATE OF PREVIOUS PUMP-OUT: '21 /77
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.)
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Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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