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HomeMy WebLinkAboutFiume JUDITH T. TERRY ' Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS .` Southold, New York 11971 MARRIAGE OFFICER k '�® �4 �� Fax (516) 765-1823 � ® Telephone (516) 765-1801 Lai OFFICE OF THE TOWN CLERK _ TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1948-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner FIUME, LAWRENCE Mailing Address 1 1125 KENNYS ROAD Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 1125 KENNYS ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-1855 Tax Map No. section 59.00 block 7 lot 21 .000 Cross Street NORTH ROAD Date Of Last Pump Out 0/00/00 Issue Date: 7/22/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK cvFFO1 - Town of Southold A CQG' Application No./ 71/2K Judith T. Terry, Town Clerk . t Town Hall, 53095 Main Road ' ' -� $10.00 - Residential P. O. Box 1179 to f � '�"�'" $25.00 - Non-Residential Southold, New York 11971 Telephone : 1 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for - OPERATION PERMIT SEPTIC TANK or •CESSPOOL Operation Permit No. Fee $ ,f©,P® DATE 713/9g. OWNER NAME: La GO rerlee- Pi‘ GtrYie, OWNER MAILING ADDRESS: HA.5 <sevir el 5 Rd (hL d ldi . 1,/,01.7!) OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: v.) 65-- •-1 TAX MAP NO. : Section Block 7 Lot C/ CROSS STREET: 0011-44) GOi d 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.) 341 ,40-) �` 5 Signature of Applicant RECEIVED BY: Town Clerk's Office DATE: