HomeMy WebLinkAboutGebbia OFFICE OF THE TOWN CLERK ' 'c�v�FD(�
Town of Southold , CSG
Judith T. Terry, Town Clerk Yh_`; t
61Y y
Town Hall, 53095 Main Road g t
P. O. Box 1179 '• ,c
Southold, New York 11971 ' .' ?462 lap
Telephone -_
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 44 Residential xx
Non-Residential
Fee $ 10.00 •
Septic Cesspool xx
•
NAME OF OWNER: James Gebbia c/o Simicich
OWNER MAILING ADDRESS: 4250 Bergen Avenue
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Right of Way West of Cox Neck Road
Mattituck, NPww York 11957
OWNER TELEPHONE NUMBER: 516-29R-5964
TAX MAP NO. : Section 13 Block 7 Lot 19.9
CROSS STREET: Cox Neck Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential xx Non-Residential
DATE OF PREVIOUS PUMP-OUT: None
elogiseheed:07.01000.......0
Judith T. Terr
Southold Town C erk
DATE: September 11, 1986
I (TOWN SEAL)
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OFFICE OF THE TOWN CLERK S\\FFet/1'p:- ��
Town of Southold Q = Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Residential
P. O. Box 1179 cn ' ; Non-Residential
Southold, New York 11971
Telephone .*01 -45, -,/
01 , - '/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 41/
Fee $ °c'
DATE 9//7
/.°2
OWNER NAME: c) (47,2F5 //9
OWNER MAILING ADDRESS: 4 o O /3 Cid 6--(��/
7L(J c./ // 95--2
OWNER PROPERTY ADDRESS: } --7.- 0 F bei/L y w Fs-7- D F
D x /U cc 4-4- �'fuC4
OWNER TELEPHONE NUMBER: c,2 72-,5-96
TAX MAP NO. : Section //3 Block 7 Lot /9.
CROSS STREET: d Q X /v cc / AQ,4/3
TYPE OF SYSTEM: Septic Tank / New v 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.)
`„
Signature of Applicant
RECEIVED BYLCE6- L
Town Jerk's IV ice
DATE: 91.--//—/i2
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HEALTH DEPARTME NT-DATA FOR APPROVAL TO CONSTRUCT n .� XP1R>�5 TWO YEARS �= �� ONL� coARSEEL
+ 3 ROM DATE OE APPROVAL
-R-NEAREST WATER MAIN_MI - *SOURCE OF.WATER PRIVATE_PUBLIC_
*SUFF CO TAX MAP DIST m0 SECTION1�3 BLOCK 07 LOT P 9 16.6
*THERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY
OTHER THAN THOSE SHOWN HEREON. I UNAUTHORIZED ALTERATION OR ADDITION TO
* THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE NIT SURVEY is A viA,ION OF
V rnu�nawa TO THE STANDARDS OF THE SUFFOLK COUNTYDEPARTMENT
THIS •NE 5 IOL STATE EDUCATION SECTION