HomeMy WebLinkAboutDrossos (2) _ OFFICE OF THE TOWN CLERK ' c31
Town Town of Southold �� . CSG
Judith T. Terry, Town Clerk % :G y :fir
Town Hall, 53095 Main Road g
P. 0. Box 1179 t 3 '' •t W
Southold, New York 11971 _ o ��.
Telephone = .( *
(516) 765-1801
TOWN' OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR 12 Residential
Non-Residential XX
Fee $ 25.00
Septic Cesspool XX
NAME OF OWNER: Alexandra Drossos (Drossos Sn ck -Bar)
OWNER MAILING ADDRESS: Main: Road
Greenport, New York 11944
OWNER PROPERTY ADDRESS: Main Road
Greenport, New York
OWNER TELEPHONE NUMBER: 516-477-1334
TAX MAP NO. : Section 45 Block 1 Lot 13
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 30, 1986
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Judith T. Terry
Southold Town Clerk
DATE: September-29, 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK S' FOLi-
Town of Southold CDG Application No./Vie/1
Judith T. Terry, Town Clerk %t• y
� s?, Residential
Town Hall, 53095 Main Road 1=3411:�
P. O. Box 1179 cry " * . Non-Residential 6�
Southold, New York 11971 O 4 C'F $
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Telephone ‘vi:�.(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /V e7
Fee $
ar-DroS_c6is DATE
OWNER NAME: rO'S5 oS L
f
OWNER MAILING ADDRESS: C -(.rte (
.[r: dier
OWNER PROPERTY ADDRESS:
5E0-144
OWNER TELEPHONE NUMBER: I/7 7-- ) 33 c-/
TAX MAP NO. : Section .1/5.—; Block / Lot /
CROSS STREET: f�L o.� S� , 1 �
TYPE OF SYSTEM: Septic Tank I/ New Existing
Cesspool " New Existing
Residential Non-Residential "'
DATE OF PREVIOUS PUMP-OUT: D
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 Applicant
RECEIVED BY:
Town C erk's Office
DATE: , z 11
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