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HomeMy WebLinkAboutFusco o ,eEc7'— 60,y JUDITH T. TERRY � j; Town Hall, 53095 Main Road TOWN CLERK ® P.O. Box 1179 REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971 MARRIAGE OFFICER 0 Fax (516) 765-1823 `V- �! Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1983-R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool New Existing X Name Of Owner FUSCO, NANCY T. & FRANCIS M. Mailing Address 1 P.O. BOX 1213 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 6560 N. BAYVIEW ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-1868 Tax Map No. section 79.00 block 7 lot 2.000 Cross Street JACOB'S LANE Date Of Last Pump Out 0/00/00 Issue Date: 10/05/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) g p .�d�- ` JUDITH T. TERRY / Town Hall, 53095 Main Road TOWN CLERK S ® P P.O. Box 1179 REGISTRAR OF VITAL STATli;TICS Southold, New York 11971 MARRIAGE OFFICER Fax o Fax (516) 765-1823 ®. ��®.i-%71Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1983-R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool New Existing X Name Of Owner FUSCO, NANCY T. & FRANCIS M. Mailing Address 1 P.O. BOX 1213 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 6560 N. BAYV I EW ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-1868 Tax Map No. section 79 block 7 lot 2 Cross Street JACOB'S LANE Date Of Last Pump Out 0/00/00 Issue Date: 10/05/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) r J III OFFICE OF THE TOWN CLERK 'c�VFFOUrI"` `-1/4u Town of Southold N� {. . CQG- , Application No. l / f3 Judith T. Terry, Town Clerk ��� : ,- k:: .4%) $10.00 - Residential Town Hall, 53095 Main Road , P. O. Bo>i 1179 x; c.` ` �� -- ��} ,�� $25.00 - Non-Residential Southold, New York 11971 O ®: �$ Telephone 4°/.41-(' %N-• ./ �� " (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE /n -S---9 D- OWNER NAME: Pogljefil / ,03 /0 . s(i., OWNER MAILING ADDRESS: P(.0 . &X /0--/3 600' c-sb ,11 //Q7 / OWNER PROPERTY ADDRESS: (�'S ,O ' ( LB,* ,; v,,,, s 601-7-to�-7 / 0 9 1/q7 I OWNER TELEPHONE NUMBER: 640 — 76S-- /86 r (Luot...167--a0 TAX MAP NO. : Section 9 Block 7 Lot___,____ CROSS STREET: 00155 Li9/,/ TYPE OF: SYSTEM: j Septic Tank New Existing //'-- Cesspool //` New Existing Residential !� Non-Residential DATE OF PREVIOUS PUMP-OUT: - ...... y...1•%:.Y , 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.) ,q(4,,,tx.4/0P' /')/ • 4,1f3 61, Signature of Applicant RECEIVED BY.:_-. , V" �� �, To n Clerk's Office DATE: /Q 1-1 1` L, kk 2 r.3,)y L.,/ELL) go). s �)4-1, 0 L j jpus„Ca 1_,- .f- ltie66 „Ce- ZON C. CI) `!"*"%rt \, • 1 `,04 ca ® ; J ® d o" ISO G a u, LL e INK c o c_q-fi e L) �,'o r l �;o& - FY`c,w-, l 6-1-‹ 't 10 { 0 F—ficu&«