HomeMy WebLinkAboutFalleti 11I
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M �`' Town Hall, 53095 Main Road
�® ; P.O. Box 1179
tS
®� �``�•I�� Southold, New York 11971
JUDITH T.TERRY „,/jr."�� I 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. 971-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner FALLETI, JOSEPH C.
Mailing Address 1 762 NAUGLES DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 762 NAUGLES DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9699
Tax Map No. section 99.00 block 5 lot 12.001,
Cross Street LUTHER'S ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 1/09/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
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OFFICE OF THE TOWN CLERK c�\FFOtir
Town of Southold � 4 Application
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road -4 ; Residential
P. O. Box 1179 cr s ,
k ; Non-Residential
Southold, New York 11971 ®�'�•
Telephone Q( ,x3 `A�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.9)7/
Fee $ 16)
•
DATE
OWNER NAME:
OWNER MAILING ADDRESS: 77,,,/
Jr'� lie-�-�b S ids
OWNER PROPERTY ADDRESS: 7C ;. Q e
OWNER TELEPHONE NUMBER: vr,/
TAX MAP NO. : Section ‘7-9, Block � Lot /,7. 0 0 �9
CROSS STREET: / u tI'1 - 6 ,� /9-0
TYPE OF SYSTEM: Septic Tank Nit New V. Existing
Cesspool / New Existing
Residential A/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: ho V In ��
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.)
; -
S4(gnature of A.'.licant
RECEIVED BY:
Town Clerk's Office
DATE:
SURVEYED FOR:- . 11 ' 1 ./C-71 i 57/
LOCATED AT /W,4T7-/T4,/C.c' , TOWN OF `ej04/77/74:::"G® , SUFFOLK COUNTY N.Y.
LOT
MAP OF Q,e74.5Cde/43�,C, ,C=)ieo"="�deT')/ , CO. CLK. NO. FILED
SCALE 1" =4o
SUFFOLK CO. TAX MAP DATA:- ,
DIST. /000 , SEC. 096. 040
BLK. OJ`.0® LOT Pio 01�O.00
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0�/ P/O BOX 377
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JAMESPORT, L. I., N. Y. 11947
T 7. O FILE NO.// 6.6' PAGE 23 GRID/3a,
DRAWN BY