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Home My WebLink AboutDivello JUDITH T. TERRY 'L Town Hall, 53095 Main Road TOWN CLERK • T I P.O. Box 1179 REGISTRAR OF VITAL STATISTICS � Southold, New York 11971 MARRIAGE OFFICER Fax. , Fax (516) 765-1823 --- Telephone mit �1D �� Fax (516) 765-1801 • OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 141-N Residential Non-Residential X Fee $ 25.00 Septic Cesspool X New Existing X Name Of Owner DIVELLO, JOHN M. Mailing Address 1 DRAWER 1402 Mailing Address 2 City St Zip GREENPORT NY 11944-0000 Property Address 1 800 WICKHAM AVENUE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-8888 Tax Map No. section 140.00 block 2 lot 30.000 Cross Street HILL STREET Date Of Last Pump Out 0/00/00 Issue Date: 3/22/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) •� iii�' OFFICE OF THE TOWN CLERK cOFO(.,(r fu/ Town of Southold �� CQG' Application No. / ! Judith T. Terry, Town Clerk Town Hall, 53095 Main Roada � $10.00 - Residential P. O. Box 1179 cn � ,- $25.00 - Non-Residential ,.. Southold, New York 11971 O ., ,s'' -, Telephone ��A-�• X01 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERAT ION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No.'1 0 -3 2 1-13 Fee $ a o® DATE 3// F/1. OWNER NAME: -124a ,1. OWNER MAILING ADDRESS: 12 � 1 4b y OWNER PROPERTY ADDRESS: gee�(dic0.64-744 OWNER TELEPHONE NUMBER: - 2G, 3-- e't8 k TAX MAP NO. : Section / et6 Block '2/ Lot 3 CROSS STREET: ///� L -� TYPE`OFCSYSTEM: Septic Tank New Existing Cesspool New Existing 7� Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: dsf 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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