HomeMy WebLinkAboutLambiris /o y ;
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK rZ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
MARRIAGE OFFICER ®
V� ••� Fax (516) 765-1823
�
�, 62 11D® �� Telephone (516) 765-1801
r�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3001-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner LAMBIRIS, VASILIOS
Mailing Address 1 30-36 69TH STREET
Mailing Address 2
City St Zip WOODSIDE NY 11377-0000
Property Address 1 235 CAPTAIN K I DD DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8040
Tax Map No. section 106.00 block 5 lot 4.000
Cross Street LUTHERS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 4/19/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
"I
OFFICE OF THE TOWN CLERK �cvFFO(,Y.••-
Town of Southold �� _:�. CQG Application No3O0/
Judith T. Terry, Town Clerk � Y
Town Hall, 53095 Main Road
yam: I $10.00 - Residential
P. O. Box 1179 --T; ' ' ► : $25.00 - Non-Residential
Southold, New York 11971 O �
Telephone -_ 1 /i
(516) 765-1801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $jO/
DATE yiJ / 7 / 1j3
OWNER NAME: VOStIIOS ctiro,biris5
30-36 60114--
OWNER MAILING ADDRESS: s arA t i�,`ga[iAviirkaii •
t
try/ 1 107
OWNER PROPERTY ADDRESS: I44 - f
Y i. 52
OWNER TELEPHONE NUMBER: on b) age 8V' o
TAX MAP NO. : Section /6' 6 Block j— Lot 6/
- CROSS STREET:
TYPE ,OF.-SYSTEM: Septic Tank-- New Existing
Cesspool New Existing
Residential `V Non-Residential
DATE OF PREVIOUS PUMP-OUT: J0) (.../ 29
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.)
r6t41
ificrSibnatureof Applicant
RECEIVED BY: -
Town Clerk's Office
-
DATE:
C- . Kciot 1)r'
/7/ 1
1
oa k,4_0