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Home My WebLink AboutPerivolaris, Michael ee ELIZABETH A. NEVILLE /4 Gy� Town Hall, 53095 Main Road TOWN CLERK o - P.O. Box 1179 y Southold, New York 11971 REGISTRAR OF VITAL STATISTICS '�� MARRIAGE OFFICER Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER `may_"'/Ql 0�, 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. 4184-R Residential x Non-Residential Fee $ 10.00 New Existing x Name of Owner PERIVOLARIS, MICHAEL & KATHY Mailing Address 1 P 0 BOX 800 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 1155 LOVE LANE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 631-298-3839 Tax Map No. section 140.00 block 1 lot 20.000 Cross Street ROUTE 48 Issue Date: 1/22/03 Elizabeth A. Neville Southold Town clerk (TOWN SEAL) r .r OFFICE OF THE TOWN,CLERK �OFU / TOWN OF SOUTHOLD p\f ' Ij Application No.4(G �y ELIZABETH A.NEVII.I.F,TOWN CLERK �l $10.00 - Residential P.O.BOX 1179 SOUTHOLD,NEWYORK11971 �� $25.00 - Non-Residential Telephone 0 * sa0 .' • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE^( qa,(a.e3 OWNER NAME: Mt jyt 2A, S42\aki-Li---- E_,C\1 V 1 ...6 3 OWNER MAILING ADDRESS: O . \r��, an() VY\64t+ACE- ) ( Il°l5 OWNER PROPERTY ADDRESS: l\�S Lj✓� L,-a__ OWNER TELEPHONE NUMBER: 6.3.--)A aR , - '3cl TAX MAP NO. : Section / `i ° Block / Lot CROSS STREET: 731. Qj_ TYPE OF SYSTEM: Septic Tank New Existing 11111/ / Cesspool Ne - 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.) i r I?1L1 G�lit/� Sig atur of Applicant RECEIVED BY: Town Clerk's Office DATE: ......k 4 Imminaismmrmedminsma4,4* .4.44,.......44..., , : - i ... ' 7„, ...- ,../.......4 '4 ..,1 "..• fx:t\‘., ;!,;t. '... ' r . \pl A ...---- ._ \ \ As<1' s l X . • . ,. . ,S 7 / es.../... X r ' 4". ...r4X, . ,•,?4-',/ ,;,..;.%X.5" DO VII? \'' 1/4j'-‘ .....,,,f ..\0' 1 i (..„4/4. \ '0 1 Sil,Y• / ''N, ...'.. •,-.• 4 , 44 (5) I yi4 ' ) ,014- , r- •"- 0. q c,"''''' 0, `..- ...6:r , „..- , ,„ , . N. . _ 46/' \,..C'. \." , -"' (.. .- . \\,\\\ <6 13 A 0 , ... •.,4 # ri- 0‘ .A. ,.. , i`' # ,.^. ' . ';Y.'\ %'''sClsiC-- .. , .„ //1).::-<-7.6'. • z.r..f. \ to .,) .• ,7„...0:7"."\\ _15.7, *0.-„,_, & \L'4sci:- N \ '''' c:l '''/ 4 , -0 • \)----c- --. ,--,-...:-• $4 (0. ,4: 1 --- -,. ,T, ,,.. „-- , ,..,.. 4,,,...,,,;'' • ,.4.-r ,,r ...),f fl* !., • 51-3',J.S. \S; .--.6')'sc6C •---./ v •,,b.- \ t,,,,A \ .?. , .,, N.\ •S‘,444 .P•‘- , 'T J ‹c9 \P 4• . , (\, (4\,'. .4." .•-' ..-- NkV‘1°';';' • •• ... .e. . - •.'.1., a . ,.., iii'• . \\. . •g.,."_...e. , r ... ‘• ' 0 , ' • . i4"'''.> Cf,pp 1- •N''' ''- ',- \V. ..,',.7.' ce ( • -"'" \ 1C-'•' . ,...., 0...., 0'....,, --- .1 4,--... 0 'l 4 .."".. __1:6- \s,'''. ' X .. f tl--C '',"" 0 ( ' CL).„/ .... , CONC. r‘f i ,P., r> 5\ 1 Iv''',' "'r .4.,"„ . esoit (".... .." COVER N J ' J, ' r ‘-ti 4.111PC ( e•-,„;‘.. 4.• f...../• A\i'fr to- Z .`,.:". I '-:,-: :"-Z i ...?..)- . ( . Co - dk. , ' „ 1 ' ./. :,-‘ , '\ k .,.../ \ ' '\ C... "91 Or rij.. • '. .•'\ (:, ,......'....''" • .. ,.. „ ,\ . 'A /'/r. 10, . 0 K.- .) 16\ ''", ,Z "'r. ''•>•,') r '......"'•'..., ' • , \ N., ,,,, , , / ,:•.";' \ - ., ,......., .1 \1/4 / „--:, ../. ' P • I 14,„..... (-1 --P, . / \• '0 '‘),:is% .......y.,- .. ....,a.. • .1 c) °" ‘N-,<.- --•'C'''okv‘t... 1..,C) •, t 4 • '4' 0 ...) ' i _.....---"- • '' , ., \- , i • S A ' \f\- ! ..- I - Michael & Kathy Perivolaris 1155 Love Lane, Mattituck i ,..,,. ti ,. .,. ...... . ..4 .