HomeMy WebLinkAboutDrossos OFFICE OF THE TOWN CLERK '.SVFFO(,(�`;'
Town of Southold OG
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179 X51 '"� T' ► .
Southold, New York 11971 O�AI +. *'S
Telephone * t
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR11 Residential
Non-Residential xx
Fee $ 25.00
Septic Cesspool xx
NAME OF OWNER: Alexandra Drossos ,,(Drossos Motel)
OWNER MAILING ADDRESS: Main Road '
Greenport, New York 11944
OWNER• PROPERTY ADDRESS: Main Road
Greenport, New York 11944
OWNER TELEPHONE NUMBER: 516477-1334
TAX MAP NO. : Section 53 Block 1 Lot 3
CROSS STREET: Albertson Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool xx New Existing XX
Residential Non-Residential xx
DATE OF PREVIOUS PUMP-OUT: August 15, 1986
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Judith T. Ter y
Southold Town Clerk
DATE: September -29, 1986
(TOWN SEAL) -•
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OFFICE OF THE TOWN CLERK �FFO
Town of Southold ®� o�'_, Application No. .Alie//
Judith T. Terry, Town Clerk •``� -9` y.4"`
.�� 7 Residential
Town Hall, 53095 Main Road ;_ -
P. O. Box 1179 c A1M1' Non-Residential V
Southold, New York 11971 O ® P $
Telephone C 10),
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(516) 765-1801
19G 't vF-D TOWN OF SOUTHOLD
SEP 29 1986 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town Clark Southold
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ell
Fee
DATE 9/2-C �
OWNER NAME: kr—Dr0 S S oSN ( 5cosck8fv
OWNER MAILING ADDRESS: ..A4 C
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OWNER PROPERTY ADDRESS:
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OWNER TELEPHONE NUMBER: % 7 3
TAX MAP NO. : Section 63, Block 0 Lot 3
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ° New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: - j Sfr% •
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 Applicant
RECEIVED BY: Of/x_dce—
TownClerk's Office
DATE: Jxi , eirr_. Li io G
9-64($?
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