HomeMy WebLinkAboutIavarone ®��FfULir j;
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ' p eZ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER ® ®�' � Fax (516) 765-1823
I1� sTelephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2066-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner IAVARONE, ROSEANN AND PAT
Mailing Address 1 18 THE HOLLOWS SOUTH
Mailing Address 2
City St Zip MUTTONTOWN NY 11732-0000
Property Address 1 950 STROHSON ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 000-922-7532
Tax Map No. section 103.00 block 10 lot 24.000
Cross Street LITTLE NECK ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 3/04/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c0F0/,1 ,`,,•�t, �
Town of Southold � .. CQ ' Application No. p2,
Judith T. Terry, Town Clerk j � �
Town Hall, 53095 Main Road c $10.00 - Residential c3>
P. O. Box 1179cn `-x }
'�-:,,: �� $25.00 - Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /Ci
DATE 1&./2, J / 993,
OWNER NAME: g5,e-69////0 7R-71-
OWNER MAILING ADDRESS: /' . ,4 //vkiJ1J*
)ry
OWNER PROPERTY ADDRESS: 95z' v� i v 424
OWNER TELEPHONE NUMBER: yao?- 7s3�
TAX MAP NO. : Section /0 3 Block / () Lot c=.2`t
CROSS STREET: ? �C'� Z. 6.(AL
TYPE"OF- SYSTEM: Septic Tank New Existing
Cesspool � New Existing 1/1
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
,ead6
Signature of Applicant
RECEIVED BY: , - - -
Town Clerk's Office
DATE: -, . - - - -- -- -- - - ----- -- - -- - -