HomeMy WebLinkAboutGiannaris OFFICE OF THE TOWN CLERK • •c.0 F OUrt,
Town of Southold � O
Judith T. Terry, Town Clerk 'Y _ am'
Town Hall, 53095 Main Road
P. O. Box 1179 cn r'
Southold, New York 11971 Q ' '_r' �••
Telephone "'0l �0�°
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 290 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: JOhn and Anna Giannaris
OWNER MAILING ADDRESS: 5145 Main Road
East Marion, New York 11939
OWNER PROPERTY ADDRESS: Maple Lane
East Marion, New York
OWNER TELEPHONE NUMBER: 477-9579 or 477-0138
TAX MAP NO. : Section 35 Block 5 Lot p/o 5
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New X Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: NA
•
Judith T. Terryl/
Southold Town Clerk
DATE: April 28, 1987
i
(TOWN SEAL)
A
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OFFICE OF THE TOWN CLERK OFU
Town of Southold 0�$ - ..- ° CQ�'; Application No. L (
Judith T. Terry, Town Clerk .�ea �t� Residentialc
Town Hall, 53095 Main Road c ,� x
P. O. Box 1179 v' '{ `� Non-Residential
Southold, New York 11971 ® ��`
Telephone : 1 �}1 , '.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /50
Fee $ /0° 0 6
DATE ° i17/� 7
OWNER NAME: �70A s (244c Awci l! /a/4,'ia-12:1:c
OWNER MAILING ADDRESS: S/4iS /)10,/-i eO2. 7,/
/0,711937.
OWNER PROPERTY ADDRESS: b7 J ,413?�--
r iwer) ,f t >C// 9 ,
OWNER TELEPHONE NUMBER: .927-,S79- .4/7 7- 0/3g
TAX MAP NO. : Section "3 Block Lot PA) S
CROSS STREET: /1/0 1 ii PO 0/
TYPE OF SYSTEM: Septic Tank New X Existing _
Cesspool )( New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached hereto before permit may be issued.
efALed, (Locate building and system; give north arrow and feet
(,)117 `-4
1, \ of distance, approximately, to building and closest road.)
L.,
Signature of Applicant
RECEIVED BY: (- .
Town erk's O fice
DATE: 4'0i 7 er/7