HomeMy WebLinkAboutMattessich OFFICE OF THE TOWN CLERK ' '000
Town of Southoldj®'1 �)::a' ?,"0G
Judith T. Terry, Town Clerk ,j,4` rr .1f:A Ilk
Town Hall, 53095 Main Road :044.
P.
P. O. Box 1179
Southold, New York 11971 4„
Telephone _®! ‘1\%6 .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 32 Residential xx
Fee $ 10.00 Non-Residential
Septic Cesspool xx
NAME OF OWNER: Giovanni Mattessich
OWNER MAILING ADDRESS: P.O. Box 924
Southold, New York 11971
OWNER PROPERTY 'ADDRESS: 875 Hummel Avenue
Southold, New York
OWNER TELEPHONE NUMBER: 765-2657
• TAX MAP NO. : Section 63 Block 2 Lot 23
CROSS STREET: Boissea1 Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool xx New Xx Existing
(replacement)
Residential gx Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown_ (7/2/86)
I i -
Ju Yef:Terry
Southold Town Cle k
DATE: August 29, 1986
•
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cvTFair
'Town of Southold Application No.
Judith T. Terry, Town Clerk t ZI
t o Residential /�-
Town Hall, 53095 Main Road o �W �
P. O. Box 1179 ' �� Non-Residential
Southold, New York 11971
Telephone _"®( l�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL -
Operation Permit No.& c=2J •
Fee $ /79
DATE ��
(9 2 c
OWNER NAME: J f V y& yt �� �- S' S r C
OWNER MAILING ADDRESS: X11KijjVJ Jv) 1-1
J
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: f(r5
TAX MAP NO. : Section QC� Block a Lot c 3
CROSS STREET: , r91 C,Sc�Qti , p1/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New 17'°--1°-&rHisting
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUTS: 7/
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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Signature of pp icant �--�
RECEIVED BY: c�
Town Cl k's Off ce
DATE: . Q,r1 /Y/
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