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JUDITH T. TERRY ' Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r .�` Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
® �! Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3055-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner LONGO, ALBERT
Mailing Address 1 1235 ALBO DRIVE
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 1235 ALBO DRIVE
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-5982
Tax Map No. section 126.00 block 3 lot 13.000
Cross Street BRAY AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 6/29/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c��FF�(K
Town of Southold CQ • , Application No. 36,..5-5-
Judith T. Terry, Town Clerk ~ � �`'` $10.00 - Residential
Town Hall, 53095 Main Road 3 "-
p. O. Box 1179c.nf; ' ' i �`' $25.00 - Non-Residential
Southold, New York 119710 ��
Telephone( $�o
(516) 765-1801
' TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE i C(�
OWNER NAME: A t^? E ( 1,,6 Q C7.6
OWNER MAILING ADDRESS:
• f
OWNER PROPERTY ADDRESS: /a, as-- f{- L.BO
LA-Gt L N`/ n ct L/ 0— / (0/
OWNER TELEPHONE NUMBER: C.57(0) 02�� - 6-5'(f'oZ
TAX MAP NO. : Section Block Lot 3
CROSS STREET: $ tul /4 V.E.
TYPE OF SYSTEM: Septic Tank (.1.N.L'ew.2.________Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 5/81 ?-3
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 rnad,)
We-47 / ) ,
Signature of Ap.1.ica t
RECEIVED BY: -
Town Clerk's Office
DATE:
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