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HomeMy WebLinkAboutGrigonis (2) r II L xi Town Hall, 53095 Main Road `�® `� P.O. Box 1179 ®1 'sid see" �, Southold, New York 11971 JUDITH T.TERRY „,„1,1- TELEPHONE TOWN CLERK (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. 699-R Residential X Non-Residential Fee $ 10. 00 Septic Cesspool X New Existing X Name Of Owner GRIGONIS, MONICA J. Mailing Address 1 255 HARPER ROAD WEST Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 255 HARPER ROAD WEST Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-3888 Tax Map No. section 63 . 00 block 7 lot 7 .000 Cross Street WELLS AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 5/12/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) so OFFICE OF THE TOWN CLERK c51FOCA- Town of Southold Application No. G 9 9, Judith T. Terry, Town Clerk Residential Town Hall, 53095 Main Road ~ P. O. Box 1179 cry >' $5y4 :' Non-Residential Southold, New York 11971 OV 0 $ Telephone _ .( iZAlt (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. G 5 Fee $ 10'.00 DATE March 18, 1988 OWNER NAME: Monica J. Griqonis OWNER MAILING ADDRESS: 255 Harper Road West Southold, N.Y. 11971 OWNER PROPERTY ADDRESS: 255 Harper Road West Southold, N.Y. 11971 OWNER TELEPHONE NUMBER: 765-3888 TAX MAP NO. : Section 63 Block 7 Lot 7 CROSS STREET: Wells Avenue TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: NEIL) 0 ces6-- 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.) 7.7( 7.77,10, Signature of • pp, . nt RECEIVED BY: Town Clerk's Office - DATE: , , ;.,., ,.; „ap-,i4-,:,'",'L'ei.71,,,,,,,-QJ,,,.-4,:b.4,:o..,"a,i-.,,,V.I.,i,t,7:-:CY'i".. ":`ff"P.V:•;?..,.. .nzY,,;;:i?•43:i‘:;,' ., , ,,,„, - ,, ,•. ,,,. ••-,•• i'','•:: ,.•,,,',•,,,,•:,,t.-, -.:,,,!,4-•,--....,,,,,,,•• •••••••,•• .2 1„,:,••• ? , -.A, ,•,' ,, ......„ ,, .,„..„,..,..„ . . '- ‘• ' -.•..••'..-•:•>•4::,--••••-:•'•,10••,:,';•,::,4-•'..•'t,•,•vi•-•-•ri-A'-'21'fr:••,., -;•• ••:, -,';''-'-' -',"' 1,---., ''''..,A.-, C ' . . •1 . I, . .. ey ..;ii ) ; . , ."47,,2r,...:,M!'rt.,:!: :','.....'.,',-;;''.';'-4...,';',:t+?•'e .,;.,..-‘,.`)vii/s.z„;,-, „. :4. p.,, - • ,, , ,,.) -, ,',,1„,,',t..,'"; c*'-'\.&,1--.:,$ .."'', •-.',,l' -, .' ','• ,' ' ,-„ . ,'_.',:';'::,:l.-, :,:1;41;:,',4;:;'''.,, ,"„' ''';.:`,- ' ,-•;" '''' , ':'''''t;; .° " . , _ . , '_ ,,._• ,,, ,:_ , 1...,-.,‘,.V,'n.,, `, ,, .,..,•,', -.7,''•,,,:--.t?•••,,'-'if,•. ...-1'„•,,-e,f,,,,,,`,‘S4" ,'',, ' . ' ', '''41,''':''.•'f'..V''',.-. ';':',1c;‘,';',,,'-t t','.:,;.:6 0':;*'I :": " ', /V•g?° 41 . .. Ilf).az itai SUFFOLK COUNTY:DEPARTMENT,OF HEALTH SERVICES' •-' , • .:•• ,-• A11INGLE 6FANDWEI.LING ONLY'';',':`:,,'„'•--',.. ,,: ' • S . 1, D4Y-11:1S'iitt7 1\ ‘ - • . . se. Wage 4iSposarand:water siipply fa litres for this and/or N. 4\ \.) location have been Inspecteci by this Department'and/er .4, other:agencies and be seisf . ' '-poe- • : tr". • . f.Gip , Chief•of Bureau of Wastewater ManotemerK ) •Z ih IA V r‘ v , \IA V, • . , o . - , , • •,3,, . •. ,, , ' ..„ . ,,. ,• ,,, . , , ... ' , ..... . • , ,, , , „ / . r,L , , , J , • .• ' A , , . , • 1 • L.. ..{...\ \NI ,..1\ . -.e,-,,,•..-,'74-e-'-'e- ‘ti N. \I \I‘ 11,\9 4St. k‘ a Zd. 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