HomeMy WebLinkAboutMarmarellis C
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' Town Hall, 53095 Main Road
tr, P.O. Box 1179
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H Southold, New York 11971
JUDITT.TERRY „"//i�/�' FAX(516)765-1823
TOWN
CLERK TELEPHONE(516)7654801
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. 1492-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MARMARELLIS, JOHN
Mailing Address 1 21-30 23RD AVENUE
Mailing Address 2
City St Zip ASTORIA NY 11105-0000
Property Address 1 85 OREGON ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 718-278-7843
Tax Map No. section 100.00 block 4 lot 7.000
Cross Street ELIJAH'S LANE
Date Of Last Pump Out 0/00/00
Issue Date: 7/11/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK � ��"
Town of Southold ��Fr�(�C0 Application No. /�/C
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Judith T. Terry, Town Clerk �O °''
Town Hall, 53095 Main Road ,-; ` ; : 7 $10.00 - Residential
p. 0. Box 1179 t
O ®; '� $25.00 - Non-Residential
Southold, New York 11971
Telephone OI AKA 1z6 '��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ � "r y
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DATE a'/6A
OWNER NAME: dam/ /JN //,624/9 •
OWNER MAILING ADDRESS: 7--/ s 3 d Z— 3 A-P-e
,9570/'7//9 , y ///ax
OWNER PROPERTY ADDRESS: �� O/Ci 4'/(/ 2A
/",?'777 7dCI / 4/1 //P.n.
OWNER TELEPHONE NUMBER: >/ d-- -? ) ''t2
TAX MAP NO. : Section /d a Block Lot
CROSS STREET: EL4911 '4 1-4V4.
TYPE OF SYSTEM: Septic Tank- New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
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Signat e of Applicant
RECEIVED BY: -
Town Clerk's Office
DATE:
TITLE N0. 82-52-38642
82-52-38643
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