HomeMy WebLinkAboutGiannone OFFICE OF THE TOWN CLERK qffUt
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Town of Southold ti� may. * lD
Judith T. Terry, Town Clerk
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Town Hall, 53095 Main Road '` `# r » �
F. O. Box 1179 �' w 1',
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR13 Residential
Non-Residential xx
Fee $ '25.00
Septic Cesspool -Xx
NAME OF OWNER: Eugene Giannone (Main Road Tavern)
OWNER MAILING ADDRESS: P.O. Box 862
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 13605 Main Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8100 •
TAX MAP NO. : Section 114 Blocker l Lot 4
CROSS STREET: Wickham Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool xx New Existing xx
Residential Non-Residential XX
DATE OF PREVIOUS PUMP-OUT: June 1985
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Judith T. Ter`ff"
Southold Town Clerk
DATE: September 30, 1986 -
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'cuFFO(,r -
Town of Southold �� CQG'; Application No. /(J///
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Judith T. Terry, Town Clerk . y �, _ ,
Town Hall, 53095 Main Road `. " ! Residential
P. 0. Box 1179 pi-4* Non-Residential
Southold, New York 11971
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Telephone v.( % '
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ', ? / / 3
0
Fee $ a;c°
DATE Sq-
OWNER NAME: Eve- ,616- 4 /4/O0i/E (-/-72 -1,c) 4.2)g..6 //9// ,€J
OWNER MAILING ADDRESS: . % ?i2-
/1,47/7 J< 47• //94/1
OWNER PROPERTY ADDRESS: /30 fl /�l
OWNER TELEPHONE NUMBER: 02 y K./ 0
TAX MAP NO. : Section // q L/ Block // Lot
CROSS STREET: itheX/ it/ L
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool / New Existing V
77
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.)
Sig a e of Applicant
RECEIVED BY: ,� , ec )
Town erk's 0 fice
DATE: ,,_(LP.( CYO, /1
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