HomeMy WebLinkAboutMarchica y —lox*uZ iy--
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ' _ - P.O. Box 1179
toaREGISTRAR OF VITAL STATISTICS Rl� t,
Southold,ea New York 11971
MARRIAGE OFFICER G ',� Fax (516) 765-1823
® ids 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. 1639-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MARCHICA, PIETRO
Mailing Address 1 BOX 432, 1380 SIGSBEE ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1380 SIGSBEE ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4743
Tax Map No. section 144.00 block 1 lot 6.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 3/11/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
11111
t.
IIS
OFFICE OF THE TOWN CLERK ' �FFO
Town of Southold %�_ = CQ�'' Application No./6 3�
Judith T. Terry, Town Clerk ` i- - • ,r;y '
'` � ''� ..M•,:-:� .0 � $10.00 - Residential
Town Hall, 53095 Main Road .y:
P. 0. Box 1179 ;4, 244 $25.00 - Non-Residential
Southold, New York 11971 O ®_ �O�,-J
Telephone ..( 4 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLI CAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. •
Fee $
DATE 3 - 7 - 1/
OWNER NAME: et.....-e.j., ..-
•
3a-
OWNER MAILIN � ADDc¢RESy: / 3 "-v; A? af.
OWNER PROPERTY ADDRESS: / 3 , 0„ - a_
OWNER TELEPHONE NUMBER: ®2- ef.-- (( 7 , ,
TAX MAP NO. : Section Block Lot ,Q , .2 '.1 .9
CROSS STREET:
TYPE OF SYSTEM: Septic Tank/ New Existing /
Cesspool til New Existing \/
Residential 17 Non-Residential
DATE OF PREVIOUS PUMP-OUT: a - - lr -
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.)
LT, t ,isem
Signature of Applicant
RECEIVED BY:
Town Clerk's ffice
REa E,
DATE: ►`
MARI1N9.1
®amu OW Mdreg