HomeMy WebLinkAboutKaralis ,'l1tl
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Town Hall, 53095 Main Road
P.O. Box 1179
Etli, ir Southold, New York 11971
JUDITH T.TERRY =„„A„„0 (516)765-1823
TOWN CLERK
TELEPHONE(516)765-65-
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. 1160-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KARALIS, BARBARA AND SAM
Mailing Address 1 21-15 32ND STREET
Mailing Address 2
City St Zip ASTORIA NY 11105-0000
Property Address 1 285 GILLETTE DRIVE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 718-626-4421
Tax Map No. section 31 .00 block 6 lot 3.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/16/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
it ii.
OFFICE OF THE TOWN CLERK sc�VFO/AV
Town of Southold �� QG' , Application No. ///'
Judith T. Terry, Town Clerk .` * rif 4;. y
Town Hall, 53095 Main Road
.,,:_.,; L Residential
P. O. Box 1179 crs Non-Residential
Southold, New York 11971 O O%c-
Telephone (/.(- [ stP
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $_I -� 7-0.
DATE 6 - - ZS /
OWNER NAME: /30f tiara - g) 1/9 ,-20/‘ //--S
OWNER MAILING ADDRESS: vQ J /LC c ?.27'
y
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OWNER PROPERTY ADDRESS: , "5 G/JJG1Tj ,?) 1>e
L Qs r10L- /1Q27
OWNER TELEPHONE NUMBER: 6J/.07- '9y�)-' &) L/77- CJg7.
TAX MAP NO. : Section , Block Lot S9
CROSS STREET: 61/I-e -e „Drive_
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool, , New Existing
Residential Non-Residential V i
DATE OF PREVIOUS PUMP-OUT: A['ME ,Pe,9,27-ly 6 - / -
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.)
Sig ature of Applicant
RECEIVED BY: -
Town Clerk's Office •
DATE: