HomeMy WebLinkAboutChinnici, William , �,O��S�FFOi,t0
ELIZABETH A. NEVILLE 1 O%
��� ; Town Hall, 53095 Main Road
TOWN CLERK 1 CO - P.O. Box 1179
h Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER `=y1 *40.;,106,, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _.�, southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4132-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MICHAEL CHINNICI
Mailing Address 1 12 WINTERGREEN DRIVE WEST
Mailing Address 2
City St Zip MELVILLE NY 11711.7-0000
Property Address 1 1175 SANDY BEACH ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 631-424-1069
Tax Map No. section 43.00 block 4 lot 40.000
Cross Street BAY ROAD
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Issue Date: 3/04/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK C0FU
t'Q -TOWNOF SOUTHOLD p )
Application No`(t 3 2-
ELIZABETH A.NE ILLS,TOWN CLERK �
�
.1"4 � $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 $25.00 - Non-Residential
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION RECEIVED
for
FEB 2 6 2002
OPERATION PERMIT
SEPTIC TANK or CESSPOOL Southold Town Clerk
Operation Permit No.
Fee $
DATE 47_4 it,
OWNER NAME: P I i&J e-' ��1Y11(l 1 GI
OWNER MAILING ADDRESS: 12 ) bii- Uel_
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OWNER PROPERTY ADDRESS: /1 7 • ,I dri f •
OWNER TELEPHONE NUMBER: (033 1 - - ID 6 di
TAX MAP NO. : Section 43 d 0 Block / Lot /
CROSS STREET: AS JC_Ct
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New . 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 building and closest road.)
Ott/240e, • -
Signature of App icy
RECEIVED BY:
Town Clerk's Office
DATE: