HomeMy WebLinkAboutFanizzi cr
Town Hall, 53095 Main Road
� �� P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY �` � TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR Oh VITAL STATISTICS OFFICE OF THE TOWN CLERK
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 929-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner FANIZZI, ANDREW J., JR.
Mailing Address 1 FANIZZI, ELEANOR D.
Mailing Address 2 P. O. BOX 376
City St Zip EAST MARION NY 11939-0000
Property Address 1 370 DOGWOOD LANE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-0518
Tax Map No. section 38.00 block 5 lot 3.000
Cross Street PARSONS BOULEVARD
Date Of Last Pump Out 0/00/84
Issue Date: 11/25/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
SI i`�'
OFFICE OF THE TOWN CLERK �FF�
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Town of Southold �� CQ ' Application No.
Judith T. Terry, Town Clerk ��, ` $t y
Town Hall, 53095 Main Road -,, 4 iResidential
P. O. Box 1179 Cr3 ;¢ hi
�` Non-Residential
Southold, New York 11971 O ®lit /�`
Telephone %�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
DATE I/ 4k-r
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OWNER NAME: / r V 157142-7-1 �(�- h/�i�J'�� j .130z.zy
OWNER MAILING ADDRESS: 0O( 3 7 G
C .s M - 0 ,'/• /m3 ,
OWNER PROPERTY ADDRESS: s3 7 v 1 G- wd-o))
OWNER TELEPHONE NUMBER: LI -7 7 0 5 11
TAX MAP NO. : Section -3 8 Block Lot
CROSS STREET: 6loa 2/>17/,'&72-5 6�y s - -- �� /7q
f"' 6--Rs ovs 13 ivc\
TYPE OF SYSTEM: Septic Tank g/ New Existing
Cesspool V New Existing 17
Residential 1r Non-Residential
DATE OF PREVIOUS PUMP-OUT: /O/ $�
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.)
4 Signat re o a t
RECEIVED BY: 44c-z( Q
RECE4tl T[ Town lerk's Office
DATE: NOV 2 5 1988
Ton Cm toite,old
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