HomeMy WebLinkAboutRodia '„' 4 Town Hall, 53095 Main Road,
" Vii' P.O. Box 1179
e0� � 1g 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. 1342-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RODIA, ALFRED T.
Mailing Address 1 P. O. BOX 236
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 665 PEQUASH AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7392
Tax Map No. section 103.00 block 7 lot 26.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 12/15/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK CO Fair. '
Town of Southold � ; CQG' Application No. /3
Judith T. Terry, Town Clerk }r 4 Pg
Town Hall, 53095 Main Road s' 21 . :'� $10.00 - Residential
O. Box 1179 unT � l+
P. � � .•.� � • $25.00 - Non-Residential
Southold, New York 11971 0,ZCSAg
Telephone •(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /6
DATE /2 T''$• /
OWNER NAME: / / /T l7 _ 'ODI12- •
OWNER MAILING ADDRESS: ? 0• ?3.0 4/ 2-3
e07- 67/2 - rN / //93)'
OWNER PROPERTY ADDRESS: 66S VV QU/- H « VL-�
OWNER TELEPHONE NUMBER: 734 - 73g Z
TAX MAP NO. : Section 103 Block Lot 2.6
CROSS STREET: 1-Y?
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential t/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: / g'9
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.)
4,t(tr
ignature of Applicant
RECEIVED BY: ti�cGrL
Town lerk's ffice
DATE:
DEC 1 ;., its0.1
Town Merk Southold
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