HomeMy WebLinkAboutPalacino, Salvatore I�,�o�OS ,coG
ELIZABETH A.NEVILLE ���� t‘ Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER - �, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �, Ql �a��1� Fax
(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. 4180-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner PALACINO, SALVATORE
Mailing Address 1 11 WHEELRIGHT WAY
Mailing Address 2
City St Zip SMITHTOWN NY 11787-0000
Property Address 1 790 OAK STREET
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 631-642-3667
Tax Map No. section 136.00 block 1 lot 38.000
Cross Street PIERCE DRIVE
Issue Date: 12/27/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
a
OFFICE OF THE TOWN CLERK .
TOWNOFSOUTHOLD ,� Application No. S�
ELIZABETH A.NEVILLE,TOWN CLERK .L $10.00 - Residentia l
P.O.BOX 1179 •
cr3
SOUTHOLD,NEWYORK 11971 '� $25.00 - Non-Residential
Telephone �.( * 04"..1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE (Z- 27 O2
OWNER NAME: SALVAT E 'r 4Lft-CIAJO
OWNER MAILING ADDRESS: 1 ( (AJ Lem l ric k± i
cc ‘ 4-e)W Ll ov Y 11 '7817
OWNER PROPERTY ADDRESS: 790 0,A K
te.._H U NY it
OWNER TELEPHONE NUMBER: 642' 3 6C
TAX MAP NO. : Section I to Block I Lot 3 B
CROSS STREET: P) T> _
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.)
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Signatur- of ' pplicants
RECEIVED BY: "" \ •
own Clerk's Office
DATE:
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