HomeMy WebLinkAboutRomeril A'4W ,Y'€rt,z Vic'_ ,
Town Hall, 53095 Main Road
.VD `; `' P.O. Box 1179
if° Southold, New York 11971
JUDITH T.TERRY ~-i/1 !'!!I' FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 1415-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ROMERIL, ALBERT J.
Mailing Address 1 1265 VANSTON ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1265 VANSTON ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7146
Tax Map No. section 111 .00 block 4 lot 26.003
Cross Street WUNNEWETA ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 3/14/90 Judith T. Terr
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'f cc'
Town of Southold Q3 k0
��, µ.. Application No. /1-71/5
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road a $10.00 - Residential
P. O. Box 1179 cry yr 5f_��t`
��-�c ���•� • $25.00 - Non-Residential
Southold, New York 11971 O "®' ••$
Telephone t
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
• OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /D
DATE 3 °- 142. -rd
OWNER NAME: �� LpL •
-
•
OWNER MAILING ADDRESS: /R6.rPS 'T-1iJ
eLt ) b--.) Air L Lq 3 -
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 5-7C 73 ._ I 6
a -
TAX MAP NO. : Section /11 Block Lot (a .3
CROSS STREET:
TYPE OF SYSTEM: Septic Tank 17 New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: `' , kS
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.)
401//,'
Signat a of Applicant
•
RECEIVED BY: & c,
Town C4'erk's Off ce
DATE: . 3// 4(9U
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