HomeMy WebLinkAboutIzzo (2) • ,y ,f041II1e7..y'..
11.
COP
JUDITH T. TERRY �
� - Town Hall, 53095 Main Road
� � ,
.` � P.O. Box 1179
REGISTRARTOOF VITAL STATISTICS CLERK
Southold, New York 11971
MARRIAGE OFFICER y �� Fax (516) 765-1823
® � � Telephone (516) 765-1801
,N®1 0 ,,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1661-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner I ZZO, ERIC N.
Mailing Address 1 1795 SHIPYARD LANE
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 1795 SHIPYARD LANE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-0118
Tax Map No. section 38.00 block 1 lot 19.000
Cross Street ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 4/08/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFiiiICE-c'�F THE TOWN CLERK �c,\\FFO(,r�'''
Town of Southold �% =; CQG- Application No. / d)
Judith T. Terry, Town Clerk . "." "• _ •,,
Town Hall, 53095 Main Road ~ '"i_`= :' $10.00 - Residential
P. O. Box 1179 i t, �i $25.00 - Non-Residential
Southold, New York 11971 O - �`
Telephone -_Oj 1% • •.1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE g 2-7- i`
OWNER NAME: C,,r[, L A) ,12zc7 •
OWNER MAILING ADDRESS: /7 c' .S SAyfe;/tT-c/ l_aA,,5_
E• rea•-z e) /v % //71
OWNER PROPERTY ADDRESS: ,k_e
OWNER TELEPHONE NUMBER: 5/ (• , `/72 — d ii
TAX MAP NO. : Section Block Lot
CROSS STREET: R 7 e 7
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ iNew Existing .i.------'
Residential ,_----'"-1 Non-Residential
I
DATE OF PREVIOUS PUMP-OUT: 1*\ w-e.� I
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__ -,_ N,t
4 ..
Signature of Applicant
RECEIVED ?Vi /V___./LA--prey .
Town Clerk's Office
DATE: �
> }
w-
~- @
� J /
� .
(3‘{
� �
n»
F7
'. ~~ ` s
, / ^
/+�*
� -
C . '
���� (
'
o eC5,00
-
'-- _ - � _ `'
-
_-__-_ _'
.`` .