HomeMy WebLinkAboutMazzei •
OFFICE OF THE TOWN CLERK •
Town of Southold �� # �G
Judith T. Terry, Town Clerk v Z 4r'- I`.=
Town Hall 53095 Main Road
P. 0. Box 1179 •' it
Southold, New York 11971
p *,ate ,�
Telephone 'At 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 310 Residential x
Non-Residential
Fee $ 10.00 Septic Cesspool x
NAME OF OWNER: Frank Mazzei
OWNER MAILING ADDRESS: 53 Peconic Lane
Peconic, New York 11958
OWNER PROPERTY ADDRESS: 53 Peconic Lane
Peconic, New York
OWNER TELEPHONE NUMBER: 516-765-1258
TAX MAP NO. : Section 74 Block 5 Lot 7
CROSS STREET: Carroll Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing - X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Ter
Southold Town Clerk
DATE: June 11, 1987 '
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK c.3�FF17 �
Town of Southold �,..-•. L'®G Application No. 27
Judith T. Terry, Town Clerky
Town Hall, 53095 Main Road a _ • :C 7 Residential
P. O. Box 1179 '' Non-Residential
Southold, New York 11971 O ® �'•
Telephone ( `�
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.C_.57/O
Fee $ �b
DATE
OWNER NAME: F/Qi}/tlie e2Z��
OWNER MAILING ADDRESS: �,�j �QGOIQ/ tom' .69/11e.
f eG D , c X11/ /19.rt
OWNER PROPERTY ADDRESS: Fe 0,4j
Pee.'#vic- ivy
OWNER TELEPHONE NUMBER: 677
TAX MAP NO. : Section 7z/ Block Lot 7'
CROSS STREET: CO /226 C- E
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 211,
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.)
7l:"j
Signature f
RECEIVED BY: C f-C6� .`
Town Clerl s Office
RECEIVED
DATE: JUN 11 173
Town Clerk Southold
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