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HomeMy WebLinkAboutSpinthourakis Ypn 4001., �4 erttis ct, " a ' Town Hall, 53095 Main Road • ,ms® �c et P.O. Box 1179 kAlai ;i'" Southold, New York 11971 JUDITH T.TERRY FAX(516)765-1823 TOWN CLERK TELEPHONE(516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 88-N Residential Non-Residential X Fee $ 25.00 Septic Cesspool X New Existing X Name Of Owner SPINTHOURAKIS, HELEN Mailing Address 1 BLUE DOLPHIN MOTEL Mailing Address 2 P. O. BOX 79 City St Zip EAST MARION NY 11939-0000 Property Address 1 MAIN ROAD Property Address 2 City St Zip EAST MARION NY 11939-0000 Owner Telephone No. 516-477-0907 Tax Map No. section 31 .00 block 6 lot 17.001 Cross Street OLD ORCHARD LANE Date Of Last Pump Out 0/00/00 Issue Date: 5/16/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) 0 `• OFFICE OF THE TOWN CLERK „���Fae Town of Southold �� - CQG' , Application No. �� Judith T. Terry, Town Clerk ~ .G $10.00 - Residential Town Hall, 53095 Main Road : P. O. Box 1179 cr3 T'-. ^; *► ;' $25.00 - Non-Residential Southold, New York 11971 *-$ "104 Telephone Y► '� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERAT ION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee b`2P--- DATE Ad to : AV OWNER NAME: �. , 41"..A . /.1L OWNER MAILING ADDRESS: ,p, 6p7/' 79; - alhit iId. 227c k,/ 2 /7R??? OWNER PROPERTY ADDRESS: Po, 609 MIlr ,4 r &ad+ 2140.kuitSik NY, / i937 OWNER TELEPHONE NUMBER: �l6) TAX MAP NO. : SeQ&2 ctionn03/ . 00 Block 06 , 00 Lot QJ3, -D/l. ao � p f CROSS STREET: , TYPE OF SYSTEM: Septic Tank '` New Existing I Cesspool New Existing Residential Non-Residential (\ DATE OF PREVIOUS PUMP-OUT: LOCATION MAP: Must be attached hereto •efore_ permiLmay be issued. _ • (Locate building and system; give north arrow' and feet _ of distance; approximately, to building and closest road.) nat - -gYrpplicant RECEIVED BY: Town Clerk's Office DATE: rag aie "---2°'--1 7,1 , : . oi . i l•- ,-.,-.•-•-•,--,:it..-„,%, , ...;.1 . • - ., • . . , _ - . •;;,...-,r4u-:......ii,-,, -.-,- :. ' ' • - 1-,, .'Ir7 1„-33X13,'3•!•,'13!.,3C'd'3,.';'e :.„ 1. , ^;. ,'.. -- .-- • :L,•:,..'..,,4 . _ ' II) ;.=• 40":-S.': ..'' ' ,- • ,'' • ' v .---,---1 , ..... . ,t,„,,,?„1,..,:„.,•. = ,.._.. ..:5-,1e:::'!, :;:i:,:S1);1 V: _ 1,-. 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