HomeMy WebLinkAboutZito, Ronald co N.
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ELIZABETH ��,a y�; Town Hall, 53095 Main Road
A.NEVILLE
TOWN CLERK % o • P.O. Box 1179
y Southold, New York 11971
REGISTRAR OF VITAL STATISTICS /Pt
MARRIAGE OFFICER , Fax (631) 765-6145
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RECORDS MANAGEMENT OFFICER `�--_ �a��i��, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - �� southoldtown.northfork.net
OFFICEOF THE
ppTOWN
LDCLERK
SOUTHOLD WAS IATERU DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4171-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner ZITO, RONALD
Mailing Address 1 568 MCULLUCH PLACE
Mailing Address 2
City St Zip HAWORTH NJ 07641-0000
Property Address 1 1185 BUNGALOW LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 201-387-1971
Tax Map No. section 123.00 block 3 lot 16.000
Cross Street CENTER STREET
Issue Date: 10/25/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
N
OFFICE OF THE TOWN CLERK c' FO
TOWN OFSOUTHOLD O`�5 Application No.
ELIZABETH A.NEVILLE,TOWN CLERK • ,
$10.00 - Residential
P.O.BOX 1179 ✓
SOUTHOLD,NEW YORK 11971 $25.00 - Non-Residential
Telephone( 41
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT -
SEPTIC TANK or CESSPOOL
Southold Town Clerk
Operation Permit No.
Fee $ /0 ' °rO
DATE /0 /7 162a
OWNER NAME: FOAM LL ZIT-o
OWNER MAILING ADDRESS: 54,g c CULI-0C1f PLi4GE-
l4AWoRrf4, ALT- onto
OWNER PROPERTY ADDRESS: H6 BOX/GA Low LAME
itI ATriruck , A/ y ii95a
OWNER TELEPHONE NUMBER: (°4)387' /97/
TAX MAP NO. : Section /a 3 Block 3 Lot /6
CROSS STREET: CEA/ TER STR EET—
TYPE OF SYSTEM: Septic Tank New / Existing
Cesspool New V 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.)
Signature
oad.)
Signature of App ' nt
RECEIVED BY:
Town Clerk's Office
DATE:
Ron Zito
1185 Bungalow Lane
Mattituck
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