HomeMy WebLinkAboutMangiamele JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK rim P.O. Box 1179
REGISTRAR OF VITAL STATISTICS • * �1 Southold, New York 11971
MARRIAGE OFFICER ` �� jit Fax Fax (516) 765-1823
®1 ,00 i � Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3034-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MANGIAMELE, KATHLEEN
Mailing Address 1 3180 DUCK POND ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 3180 DUCK POND ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5719
Tax Map No. section 83.00 block 2 lot 19.007
Cross Street OREGON ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 5/25/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK .0�FF�
Town of Southold � cQG_ Application No.
Judith T. Terry, Town Clerk
Town •Hall, 53095 Main Road ' $10.00 - Residential
� s�a
p. O. Box 1179 cT 1-3 tri z $25.00 - Non-Residential
Southold, New York 11971 u.O 0� �"
Telephone ?j N
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
•
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ (n
DATE ijiY3
OWNER NAME:
e•-•tat12Zi`-- 6441 (a -111
•
OWNER MAILING ADDRESS: 3 l ktQk ,P1 I r�
( (-s a c
- OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: l J , I
TAX MAP NO. : Section . Block Lot
CROSS STREET: Or v (�
TYPE- _New Existing l�
/ t1
Cesspool New Existing
Residential i� Non-Residential
DATE OF PREVIOUS PUMP-OUT: I
J
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.)
1 -
Signature of Applicant
RECEIVED BY: —
Town Clerk's Office
DATE:
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o� SURVEY FO -R
o O. JOHN TABER B MARY TABER
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O� AT Cl/TC•NtJG�/� '” AUG. 3, /99
TOWN OF ,�9UTHOLO ' -DATE JULY 18,198
SUFFOLK COUNTY, NEW YORK •
SCALE: " = 50'
,\ CERT/RED. j : „NO. 83 —SOB
l *UNAUTHORIZEC ALTERATION OR ADDIT'ON TO THIS �
SURVEY IS A VIOLATION OF SECTION 7200 OF THE CE
NEW YORK STATE EDUCATION LAW CH/CAsq rintE %NSURANCE CO
-
*COPIES OF THI; SURVEY NOT BEARING THE LAND 4
SURVEOR'S INK,:D SEAL OR EMBOSSED SEAL SHALL JO/y/yi '4Rn`(��`9
NOT BE CONSIDERED TO BEA VALID TRUE COPY NeiRTE1 R4�+
*GUARANTEES Ih01CAfED HEREON SMALL RUN ONLY TO * v •> '•"^ "' � ST COM PA
THE PERSON FOR'WHOM THE SURVEY IS PREPARED, P E' �'I `�,
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(WENT
AND ON MIS BEHALF TO THE TITLE COMPANY,GOVERN- '. -' r o
COUNTY TAX MAP MENTAL AGENCYANA lEN-gltrr. iticrt.,,,,..., E_., �. Y