HomeMy WebLinkAboutGiorgi �),fu ece-
uitrt Town Hall, 53095 Main Road
t,cam® 44, P.O. Box 1179
4 A $�®�,i! Southold, New York 11971
JUDITH T.TERRY �- %i�"�' 765-1823
TELEPHONE FAX (516)765-1801
TOWN CLERK
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. 1363-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GIORGI, ALESANDRO
Mailing Address 1 618 BAILEY AVENUE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 618 BAILEY AVENUE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0898
Tax Map No. section 34.00 block 4 lot 4.000
Cross Street MAIN ROAD (ROUTE 25)
Date Of Last Pump Out 0/00/00
Issue Date: 1/11/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK 'q•,FFO►
Town of Southold Application No. f3 (Q,3
Judith T. Terry, Town Clerk '� VC
.*Al')
Hall, 53095 Main Road � ,F � '', $10.00 - Residential
P. O. Box 11791
0/ $25.00 - Non-Residential
Southold, New York 11971 � •�`
Telephone t •
� •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /�7)
DATE ,/Z—A-- 9
OWNER NAME: i4H I---54i,7j •
OWNER MAILING ADDRESS:
-OWNER. PROPERTY ADDRESS :
OWNER TELEPHONE NUMBER: //77 678 y(9
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
esspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1 ` `07
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.)
c4C-CEIVED /
1„3!'i '.L /./
Signature of • pp scant
Um !Clerk Southold'
RECEIVED BY:
Town Clerk's Office
DATE:
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