HomeMy WebLinkAboutLagrego OFFICE OF THE TOWN CLERK
Town of Southold � n 7� -e7,
Judith T. Terry, Town Clerk O F ,f
Town Hall, 53095 Main Road
P. O. Box 1179 itin
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Southold, New York 11971 `
Telephone Ql y�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 584 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: John F. LaGrego
OWNER MAILING ADDRESS: P.O, Box 1425
Southold. New York 11971
OWNER PROPERTY ADDRESS: 5025 North Bayview Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-5794
TAX MAP NO. : Section 79 Block 3 Lot 19
CROSS STREET: Ship's Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing X
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: August 1987 •
Judith T. T ry
Southold Town Clerk
DATE: January• 26, 1988
(TOWN SEAL)
TI III
OFFICE OF THE TOWN CLERK c.3 1FO CQG
Town of Southold Application No. 15—(?-il
Judith T. Terry, Town Clerk
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Town Hall, 53095 Main Road Residential c./
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P. O. Box 1179 trs A #;Y �� z' Non-Residential
Southold, New York 11971 O ® TM= off'`,
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Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: --WAIN' r Les GLiz_e-610
OWNER MAILING ADDRESS: ? 0-6
S-6„_QA)cle, (k) 9
OWNER PROPERTY ADDRESS: s,a- � i0 a
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OWNER TELEPHONE NUMBER: ct 4
TAX MAP NO. : Section - 1 v Block 3 Lot _ 9
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool c// New Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: 101-7
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.)
AilLr) / 4 "\
�-� Signature of '19plic�nt
RECEIVED BY:
Town Clerk's Office
DATE:
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