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HomeMy WebLinkAboutLivanos ti .. ea 1/4 Town Hall, 53095 Main Road P.O. Box 1179 ® ® 0�� Southold, New York 11971 JUDITH T.TERRY ®� ��� "��,��oo.001/����. FAX(516)765-1823 TOWN CLERK TELEPHONE(516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1234-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner LIVANOS, MICHAEL V. Mailing Address 1 P. O. BOX 863 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 730 PINE NECK ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-4752 Tax Map No. section 70.00 block 8 lot 17.000 Cross Street GARDNERS LANE Date Of Last Pump Out 0/00/00 Issue Date: 8/25/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) * /°-.' OFFICE OF THE TOWN CLERK c���FO(., ' Town of Southold Q - �� Application No//.23 Judith T. Terry, Town Clerk „or a . Town Hall, 53095 Main Road t **1 " _. -< $10.00 - Residential p. 0. Box 1179 cn • $25.00 _ Non-Residential Southold, New York 11971 O ® 3Oi`1,, Telephone ®j • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ 101 ©,5.-- DATE V / • OWNER NAME: L.1 ,) AIitiS OWNER MAILING ADDRESS: ' os 8 g3 b K, OWNER PROPERTY ADDRESS: �� �� G� �1��=,� 5, /\J VDRL g 7 OWNER TELEPHONE NUMBER: 1 6 4- 7 5 a_ TAX MAP NO. : Section 070, p 0 Block O . 0'0 Lot 401 '7. ®o CROSS STREET: GP(A_R 00-NE ,S La...77F TYPE OF SYSTEM: Septic Tank ,New Existing Cesspool X New Existing 24 Residential .?4 Non-Residential DATE OF PREVIOUS PUMP-OUT: r.� - �„ to� , 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.) v�J� yr Signature of Applicant RECEIVED BY: Town Clerk's Office DATE: s,� I j