HomeMy WebLinkAboutCacioppo, Joseph (3) if
ELIZABETH A.NEVILLE �`t o4 \ Town Hall, 53095 Main Road
TOWN CLERK % Ai P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS , O.* tSouthold, New York 11971
MARRIAGE OFFICER 'F 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER 4's, 4)",.'1 Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER :'� �gait southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 X or Non-Residential @$25 Application No. sie
Permit No.
Owner Name SoS�P i 4- kik/ CACioPPo
Owner Mailing Address 1 8 3 5 Pa-c K R'ie
1 N'/ 119 S 2
It ll
Owner Property Address S A-114
Owner Telephone No. S ( fo • 2_1? ' q 2 /'1 1.1-- ' '7S L O I-/ a
Tax Map No: Section 12 3 Block Z Lot 3 /
Cross Street F ara.-loo ka. AVC •
Please check each that applies: New Construction ✓
Alteration to Exis ing System
Residential V Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submi •: • - - • SCHD approval.)
41
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Sill•tu eofApplicant J Date
Received by:
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JOSEPS CACIORPO
1835 PARK AVENUE
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