HomeMy WebLinkAboutGiordano JUDITH T. TERRY z .G : Town Hall, 53095 Main Road
TOWN CLERK • ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS trl .` - Southold, New York 11971
MARRIAGE OFFICER ® ®�
+� Fax (516) 765-1823
411 �� .� 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. 2035-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GIORDANO, JOSEPH T.
Mailing Address 1 790 DONNA DRIVE -
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 790 DONNA DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5076
Tax Map No. section 115.00 block 15 lot 19.000
Cross Street NEW SUFFOLK AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 2/22/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
A
OFFICE OF THE TOWN CLERK 5OF0(,r =
Town of Southold Application No. .6203S"-
Judith
263Judith T. Terry, Town Clerk . ' �; i;
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 v' i= i `
�� $25.00 - Non-Residential
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Southold, New York 11971 O `� ��• *-•�Telephone = ,(
(516) 765-1801
TOWN OF SOUTHOLD -
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: A ( D L7 !o r-4) Fl lq'b
-OWNER MAILING ADDRESS: _ (M
4:1—I (i dg
OWNER PROPERTY ADDRESS: ge., _ .-.
OWNER TELEPHONE NUMBER: 6-I (0_-CIA")
TAX MAP NO. : Section Block Lot
CROSS STREET: YLe 1_1_7 , P� �, acL
TYPE OF SYSTEM: Septic_Tank New Existing
Cesspool Com' New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: „,?wil i
A 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.)
.v $5 Vat
n� Ipt - - J Signature of Applicant
._
RECEIVED BY:
Town Cle k's Office
DATE: