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OFFICE OF THE TOWN CLERK • •c5IFOU(e:�
Town of Southold � `` .. -- Oyu
Judith T. Terry, Town Clerk s . , ��
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971 =O�` �0�-�.•
Telephone _�yff�l [
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT -
SEPTIC TANK or CESSPOOL
• Operation Permit No. 239 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Peter L. Ficini
- OWNER MAILING ADDRESS: 630 Terry Lane
Southold, New York 11971
•
OWNER PROPERTY ADDRESS: 630 Terry Lane
Southold, New York 11971
OWNER TELEPHONE NUMBER: 516-765-1866
TAX MAP NO. : Section 65 Block 1 Lot 11
CROSS STREET: Hobart Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Judith T. Term
Southold Town Clerk
•DATE: March 31 , 1987
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c,\\FFOU( --
Town
Town of Southoldpp °-3
A lication No. //
. A:..4.`+ D '
Judith T. Terry, Town Clerk z. � ,.
Town Hall, 53095 Main Road u" Residential
P. O. Box 1179 u' K, .+ y ` Non-Residential
Southold, New York 11971
Telephone 0.( 0 ��,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 02-3 9
Fee $ /v
DATE
OWNER NAME: a,-1_'GR
OWNER MAILING ADDFS V R,�, -j L t
OWNER PROPERTY ADDRESS: /� fW L
OWNER TELEPHONE NUMBER: 76S-- 101(3C:,
TAX MAP NO. : Section Block / Lot 1�
CROSS STREET: J-/ O/3A- le T.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential V 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.)
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Signature of App icant
RECEIVED BVE'!•1~1:'.)
Town Jerk's O fice
ry MR 2 $ 1987
DATE:
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