HomeMy WebLinkAboutRizzi _A: 3
le Pio
3,1 6114V BUS
Town Hall, 53095 Main Road
P.O. Box 1179
® �� �I Southold, New York 11971
JUDITH T.TERRY 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. 1009-R Residential X - Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RIZZI, NORMA A.
Mailing Address 1 24 OSBORNE ROAD
Mailing Address 2
City St Zip GARDEN CITY NY 11530-0000
Property Address 1 ARSHAMOMAQUE AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5495
Tax Map No. section 66.00 block 3 lot 12.000
Cross Street HIPPODROME DRIVE
Date Of Last Pump Out 0/00/00
issue Date: 2/08/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE, OF THE TOWN CLERK COMA'
"Town
"-Town of Southold �� CQG' Application No. /009
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road c Residential X
P. O. Box 1179 _ *i Non-Residential
Southold, New York 119.71 O ff *-$
Telephone
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
C
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /c0 (o
•
DATE 0"th
OWNER NAME: /Jo 2n 2a Z..21
OWNER MAILING ADDRESS: y OS8o2dJ& - 2O
6,414-0 cry , ft) Y lIS3 0
OWNER PROPERTY ADDRESS: I4 ' !}rya ,1-c U.C. "
.Scit'rti � A) Y, IIRi
OWNER TELEPHONE NUMBER: 76C— ,C1/9
TAX MAP NO. : Section to ca Block aj Lot ) o .
CROSS STREET: H I pPo D it-0 Er pn__
TYPE OF SYSTEM: Septic Tank New ' Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: it/a ,✓ 0--
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 Asti .nt
RECEIVED BY: tifA v
T; n Clerk's Office
DATE: �1 ��
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