HomeMy WebLinkAboutMangiamele (2) • CP r Town Hall, 53095 Main Road
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_ it � P.O. Box 1179
_4®1 „Kee. Southold, New York 11971
JUDITH T.TERRY „,,.iii,''� FAX(516)765-1823
TELEPHONE(516)7654801
TOWN CLERK
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. 1502-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MANGIAMELE, VINCENT
Mailing Address 1 1 NICHOLAS COURT
Mailing Address 2
City St Zip BETHPAGE NY 11714-0000
Property Address 1 155 SIXTH STREET
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-8234
Tax Map No. section 126.00 block 7 lot 3.000
Cross Street BRAY AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 7/25/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK 'c��FFO(,-"
Town of Southold �' .,. C� Application No. /5a7
Judith T. Terry, Town Clerk u' G
Town Hall, 53095 Main Road a C asjrt .. $10.00 - Residential
p. O. Box 1179 �. r :;' � $25.00 - Non-Residential
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Southold, New York 11971 Q `® i :0���`
Telephone -
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
1
Operation Permit No.
Fee $ f D o(rD
DATE 7/2 .5./.90
OWNER NAME: U l C! I/ t /17447 /, /19 /E .
OWNER MAILING ADDRESS: / /17/ c /� ' (^ 7,
OWNER PROPERTY ADDRESS: / 6 5.h
OWNER TELEPHONE NUMBER: 07/- go? 1/
TAX MAP NO. : Section /g 6 Block 7 Lot 3
CROSS STREET: 154'4 4 v-e .
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool t,/ New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: Gf - /9 ,0
LOCATION MAP: Must be attached hereto before permit may be issued.
,:(Locate building and system; give north arrow and feet
sof distance, approximately, to building and closest road.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
1
31-0
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