HomeMy WebLinkAboutGrigonis OFFICE OF THE TOWN CLERK •
Town of Southold \Oc� FFULII��Dy
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road -:
P. O. Box 1179
Southold, New York 11971 ��O •�`
Telephone ---777- 01 sit
(516) 765-1801 '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
• Operation Permit No. 240 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
•
NAME OF OWNER: Antone Grigonis
OWNER MAILING ADDRESS: Youngs Avenue
Southold. New York 11971
OWNER PROPERTY ADDRESS: Youngs Avenue .
Southold. New York 11971
OWNER TELEPHONE NUMBER: 516-765-3182
TAX MAP NO. : Section 55 Block 1 Lot 5
CROSS STREET: Old North Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 19, 1986 - Only time Pv.er pumped.
Judith T. Teri` '
Southold Town Clerk
DATE: March 31 , 1987
(TOWN, SEAL) .,
OFFICE OF THE TOWN CLERK ciffQ J(
Town of Southold �� CQ Application No.�
Judith T. Terry, Town Clerk �►
Residential
Town Hall, 53095 Main Road t=3
P. O. Box 1179y' 3 '. Non-Residential
Southold, New York 11971 ,••�`�
Telephone : .( �1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. o?(C7
Fee $ /3 —
DATE
QDATE ✓Jfl c-4�, 2.& 17 7
OWNER NAME: L-4.1 eY7-4
OWNER MAILING ADDRESS:
dZk i?/ 47,7( if 5 71
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: '7 1
TAX MAP NO. : Section =X Rlock Lot
CROSS STREET: ? ,- 1 . Gip ,) ef-,4
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing A
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,.sz�, 175/6 — / 4-"b
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-A licant
RECEIVED BY: C. .�3/_-� ( ifq-t
RECiM n C rk's Off4 e
DATE: LIAR
IaR 2 V 19-97
Town Cterk Southold
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