HomeMy WebLinkAboutRobertiello o,, 1/ ..
rr
061
., "7/77
JUDITH T. TERRY ;,O Town Hall, 53095 Main Road
TOWN CLERK p T 1 P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER yQ �.. ,t Fax (516) 765-1823
;- ej ..p b .' Fax
(516) 765-1801
lllll
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3131-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ROBERTIELLO, RICHARD C.
Mailing Address 1 49 EST 78TH STREET
Mailing Address 2
City St Zip NEW YORK NY 10021-0000
Property Address 1 275 SOUNDVIEW AVENUE EXT.
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 212-861-8227
Tax Map No. section 50.00 block 2 lot 5.000
Cross Street LIGHTHOUSE ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/27/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK /c�VFF�(/�'��-
Town of Southold �� CQG Application�No.
Judith T. Terry, Town Clerk :
Town Hall, 53095 Main Road a x $10.0( Residential
p. O. Box 1179 n � ��` $25.00 - Non-Residential
Southold, New York 11971 O`o �O .J
Telephone ( to
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ t • To
DATE ` /ZS /V3
OWNER NAME: I L,G,Cnvdt C 120b.evta.
OWNER MAILING ADDRESS: 4Q s-. �e-f't- . t.
OWNER PROPERTY ADDRESS: 2-75 &TA
Jo ca4a, /1/4,�• //9 7/
OWNER TELEPHONE NUMBER: 24/. 8t I d2-Z'7 S'f Zr ei60;
TAX MAP NO. : Section terrO Block 6 S 0 OZ. Lot (?B.S
CROSS STREET: L lR.nv1A, `q
TYPE OF SYSTEM: Septic Tank VNew Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: C414 k 4,.
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.)
64,Signature of Applicant
•
RECEIVED BY:
Town Clerk's Office
DATE:
•
J
d_-
-y I j
III L)
-
-to Llix-stte--12.4
_ _II. _ .. _ . _ 7 150 ?..tdr.,. --
1 ,.4't e
ii,
-
1.
l' . _. ___
- - - -
rk cif"I� [`7
-41 ,, -
._
CC;' /6.4.14. �j
, ,
,., .. -iAm._
i: _ - Gly ,t<< �t„.. ..
_ _ . _. .
-
,,
_ ._ ,;
_Mr
L24 sm,44