HomeMy WebLinkAboutGrasso x7R
-„, Town Hall, 53095 Main Road
t. ® ; " � ,% P.O. Box 1179
tis: ty e
1 ��. Southold, New York 11971 gal
JUDITH T.TERRY ---,,,,, 0! FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
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. 1265-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GRASSO, SONIA M.
Mailing Address 1 C/O GRASSO, FRANK E.
Mailing Address 2 1232 WIMBEE DRIVE
City St Zip CHARLESTON SC 29407-0000
Property Address 1 205 PINE AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 803-766-6752
Tax Map No. section 77.00 block 2 lot 29.000
Cross Street HICKORY AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 10/12/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK , 31FO
Town of Southold Q� �C' • Application No. � ��
Off, .,--r,:0-7,-, OG _ P P
Judith T. Terry, Town Clerk ` i *fy:1
Town Hall, 53095 Main Road ,s k 'a,�;' ` $10.00 - Residential
P. O. Box 1179 in t, l ,x;,,µ # i �` $25.00 - Non-Residential
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Southold, New York 11971 O � _ �'�.%`
Telephone '5r61.11-0
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
. DATE 10 //6 /89
OWNER NAME: crDN/4 f &kAsc® - c/0 • 0
OWNER MAILING ADDRESS: -.-..-- FjQf Ark Fe �IQ{� SS c2
oil/keit TEL #. 803- 7‘6-'‘7s'a• /2.302 WIN 8 k E cb R.
. OWNER PROPERTY ADDRESS s Cil 4 e-EStoNI 9-S:L°. a Q' ‘07
,,.20.5-- P/vE , rc o
So ic.-i(OLD, N. V, Inv
.----OWNER TELEPHONE NUMBER.
0
TAX MAP NO. : Section 7? Block Lot c7)-
CROSS STREET: (-/S/ y?
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential 17 Non-Residential
DATE OF PREVIOUS PUMP-OUT: 74 7 1g9
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 BY:
Town Clerk's Office ,
DATE:
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