HomeMy WebLinkAboutMasci OFFICE OF THE TOWN CLERK • FU
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Town of Southold � }h , y
Judith T. Terry, Town Clerk �� Z _ % '
Town Hall, 53095 Main Road ! '
P. O. Box 1179
Southold, New York 11971 • O
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Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 314 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Anthony Masci
OWNER MAILING ADDRESS: 81 Stonehurst Lane
Dix Hills, New York 11746
OWNER PROPERTY ADDRESS: Bridge Lane
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-499-3562
TAX MAP NO. : Section 85 Block 2 Lot 19
CROSS STREET: Route 25
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New X Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: N/A
Judith T. Term
Southold Town Clerk
DATE: June 23, 1987 -
(TOWN SEAL) •
II III
OFFICE OF THE TOWN CLERK S\\FFO(,r =
Town of Southold �� CQ ' Application No.c
Judith T. Terry, Town Clerk
Residential
Town Hall, 53095 Main Road �, :, =4.
P. O. Box 1179 to V' Non-Residential
Southold, New York 11971 czi
Telephone ,,,��
(516) 765-1801
MEWED AWED TOWN OF SOUTHOLD
JUN 16 197
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town MTh South®Ik
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ • 0
DATE SNE 131 19g' 7
OWNER NAME: RN 91)10
11 rY rS -I
OWNER MAILING ADDRESS: oe io_s " Lac_
!)Tx 1-1-ZEES I J s`/. i►
OWNER PROPERTY ADDRESS: `a CF L e C f IDIS Li AZ)
OWNER TELEPHONE NUMBER: (cj1 )
TAX MAP NO. : Section' W.S-- Block 2_ Lot 7
CROSS STREET: fLoQTC
TYPE OF SYSTEM: Septic Tank / New Gi Existing
Cesspool V New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: Irl R
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.)
Sigylture of pplicant
RECEIVED BY:
Town Clerk's Office
DATE:
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SUFFOLK CO. ..-.ALTH DEPT. APPROVAL
' H. S. NO.
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- CO, - - SYSTEMS FOR THIS RESIDENCE WILL
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SUFFOLK COUNTY DEPT. OF HEALTH
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SERVICES - FOR APPROVAL OF
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SUFFOLK CO. TAX MAP DESIGNATION:
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DIST. SECT. BLOCK PCL.
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, I OWNERS ADDRESS: ANTIOnll 1%14SC(
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GREENPORT NEW YORK
TELEDYNE POST N81329