HomeMy WebLinkAboutMazzei (2) OFFICE OF THE TOWN CLERK ' cvFFO(/(#P.�
Town of Southold , Olj�
Judith T. Terry, Town Clerk N -
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Town Hall, 53095 Main Road
P. O. Box 1179 .u' *"$
Southold, New York 11971 \,QL-g/g&
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Telephone ^ (
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 617 Residential X
Non-Residential
Fee $ 0_pp 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 YorkLt195R
OWNER TELEPHONE NUMBER: 516-765-1258
TAX MAP NO. : Section 74 Block 5 Lot 7
CROSS STREET: Carrol Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Southold Town tflerk
DATE: February 23, 198R -
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(TOWN -SEAL)
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OFFICE OF THE TOWN CLERK .CORI/Jr --
Town of Southold Application No6/7
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road - `� �_ y '4 Residential
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P. O. Box 1179 Non-Residential
Southold, New York 11971
' Telephone 0.(µ: Nit •
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
• for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: „/C'%4/A ,/,":7
OWNER MAILING ADDRESS: 5— 3 e �� J2- .e.
Pe cl a ry' e. C_ , 7 , "I/ v //
OWNER PROPERTY ADDRESS: -
OWNER TELEPHONE NUMBER: 7 6 4.5 /
TAX MAP NO. : Section JI Block 6— Lot 7
CROSS STREET: 4i�ot'aZ ,6 '
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.)
Signature of Apiallca
RECEIVED BY: e..zicpx.Gi -
Townrk's Of ice .
DATE: 02(_3/f Y