Loading...
HomeMy WebLinkAboutFontana (2) COPY o F P1Qi.OR sr • , }SE-/e% / r /SSU / yJ ,fr: '.p _ C .i ` Town Hall, 53095 Main Road ',a h�fi `4.-. y r. P.O. Box 1179 '6 "4 ,"�. ^ •�.h` Southold, JUDITH `,,' F --. ='�4 .)" o d, New York 11971 T T.TERRY -•::- 4.-721):)---�'� TELEPHONE TOWN CLERK (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. 655-R Residential X Non-Residential Fee $ 10. 00 Septic Cesspool X New Existing X Name Of Owner FONTANA, VINCENT R. Mailing Address 1 340 EAST 18TH STREET _ • Mailing Address 2 City St Zip BROOKLYN NY 11226-0000 Property Address 1 WESLAND ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No.' 718-282-8854 Tax Map No. section 59 . 00 block 2 lot 14. 000 Cross Street OAKWOOD ROAD Date Of Last Pump Out 0/00/00 -/"57 Issue Date: 3/17/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) //f'cOfode, , 1 �iiiiii\\$$$$$$ 1� lt® A cf./ w $ Town Hall, 53095 Main Road ‘14, - �� P.O. Box 1179 ®1 ° a01� Southold, New York 11971 JUDITH T.TERRY ,..,"00� TELEPHONE TOWN CLERK (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. 655-R Residential X Non-Residential Fee $ 10 . 00 Septic Cesspool X New Existing X Name Of Owner FONTANA, VINCENT R. Mailing Address 1 340 EAST 18TH STREET Mailing Address 2 City St Zip BROOKLYN NY 11226-0000 Property Address 1 WESLAND ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 718-282-8854 Tax Map No. section 59. 00 block 2 lot 14. 000 Cross Street OAKWOOD ROAD Date Of Last Pump Out 0/00/00 -/-5/ Issue Date: 3/17/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) • v �a IIIL7 iii ii OFFICE OF THE TOWN CLERK 'S\FFD( 5 S Town of Southold �� ,r CQ Application No. 4 Judith T. Terry, Town Clerk % ° y 1 ` Residential Town Hall, 53095 Main Road o . P. 0. Box 1179 u' "NZ Z -" tri •` Non-Residential Southold, New York 11971 O `� `' `" ��• Telephone -20:i (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for . - OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $/c9.dD DATE OWNER NAME: VINCC 4.,t J /---0A044.4/4 OWNER MAILING ADDRESS: 3 y0 E', J kVA /rf 6 /J / / —), OWNER PROPERTY ADDRESS: Weila ,O' .s-o4r-lfoc.o ,cjy OWNER TELEPHONE NUMBER: 7(f— 2-F )-- - ger Se TAX MAP NO. : Section 5-7 Block Lot / y CROSS STREET:©A-kwooce TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing X Residential Non-Residential -- DATE OF PREVIOUS PUMP-OUT: /lel%4 C /7/ /9e7 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.) 41-=_, - ignature of Applicant RECEIVED BY: 4-1 , Town Crk's Offi e DATE: Y'Yl c / 7. /9/," 0p Lo) 0 Q i? c?.. - i4S 5 5 o A k c,c <4 vol � � E • k s E - do �J