HomeMy WebLinkAboutMitriani r '
40
#
JUDITH T. TERRY `. Town Hall, 53095 Main Road
��� 1 k �t y
TOWN CLERK �� ® ' �y "a= � P.O. Box 1179
REGISTRAR OF VITAL STATISTICS : 6 ���r y Southold, New York 11971
MARRIAGE OFFICER 4 h3 Fax (516) 765-1823
X41 ��" Fax
(516) 765-1801
i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 120-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner MITRANI, ROBERT AND JOSEPH
Mailing Address 1 275 WOODLAND AVENUE
Mailing Address 2
City St Zip RAMSEY NJ 07446-0000
Property Address 1 GREENPORT POTTERY
Property Address 2 MAIN ROAD
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1687
Tax 'Map No. section 56.00 block 4 lot 23.000
Cross Street DOLPHIN DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 3/14/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
%.
r
Y a
•
OFFICE F. THE TOWN CLERK
'cvFFO(,- /(9 0
uwn of Southold Q l'
�,. �x� „� QG'„ Application No.
Judith T. Terry, Town Clerk - "ii y
Town Hall, 53095 Main Road /nokir t '� $10.00 - Residential
P. O. Box 1179 U' 4 - ' _.',, r . $25.00 - Non-Residential 6i 12 0
Southold, New York 11971 O 1® ''_itgr ��0
Telephone !;?eill;-
)\- #1
(516) 765-1801
TOWN OF SOUTHOLD ,
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 24Q/Q
OWNER NAME: (O J R± f 37i✓SCp4 , //C'plil/f, .
OWNER MAILING ADDRESS: a 7,5"- (A)6cc44,qkicil ,4 /,
,f0„44_, Py 1U, .-, o 75'Y6
OWNER PROPERTY ADDRESS : eepetlipon' 76p f ,� ,
ilot, iu id �0 4er, ,_sot.,-moo/t) 1L>'
7(9'7 /
OWNER TELEPHONE NUMBER: ,576 - %, 7 7-- /6 g 7
TAX MAP NO. : Section 5--(.;- Block 7 Lot v7 3
CROSS STREET: Lo 60„4..v c;/ v�• �-
, � Li/4 o __c�0iCer's
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.)
�tr
c'Pgnatur- óf Applicant
RECEIVED BY: , U-
1-1-4-------1TownClerk's Office
DATE: /�--�%�
. , , .
. ,
• ,
g-f-', 2s,
J\ul . .
--....;..
Mol (-k); I, _ _ _ �_ _ _ — -
, .
I I
�.
\I - .
i b
I .4 _ ..„......____-_____,...-1.,,,___4
�r"
' ! �
STI
j (-1/1-- I
I I I I.:
t i
i I I i
I ! S
1 I I I j I I i i
I ,