HomeMy WebLinkAboutRomanelli JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1179
REGISTRAR OF VITAL STATISTIC S � Southold,-New York 11971
MARRIAGE OFFICER
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, Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2032-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ROMANELLI, LUDIVIOCA
Mailing Address 1 1 AZALEA COURT
Mailing Address 2
City St Zip FARMINGDALE NY 117350000
Property Address 1 3140 PECONIC BAY BOULEVARD
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-249-7058
Tax Map No. section 128.00 block 6 lot 9.001
Cross Street WENDY DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 12/29/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c��FF�(��' 2-()Y)/
Town of Southold � . - _ CQ ' Application No.
Judith T. Terry, Town Clerk ,, ` kr :�
Town Hall, 53095 Main Road ��,. $10.00 - Residential
P. O. Box 1179 alb vsigt.4, tri $25.00 - Non-Residential
Southold, New York 11971 Q `�. O� ��
Telephone �(� �� '�
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
(
Operation Permit No.
Fee $t' / 0 . 00
DATE _PP
OWNER NAME: 1-U p i yi 0 12-o ln# W ELL
OWNER MAILING ADDRESS: I. 6-Z/)- -L�- C0tJ 4-)
FA-IL M i oVG vh LiC, ,1/ ) P73-3-
OWNER
I ?OWNER PROPERTY ADDRESS: 7l Liu FEL-co/10c TsLvp
1--Pru REL, (V. y.
OWNER TELEPHONE NUMBER: .5-1 aY 9 - r/OS-` -
TAX MAP NO. : Section J I Block 6 —3 Lot f
= =CROSS STREET:
TYPE, ,O_F SYSTEM:- -Septic-Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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_)
gt-Settf-ce) r
Signature of Applicant
Town Clerk's Office
DATE: .: a: •_ • -