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HomeMy WebLinkAboutRubino 40 419, JUDITH T. TERRY � O Town Hall, 53095 Main Road TOWN CLERK p T P.O. Box 1179 REGISTRAR OF VITAL STATISTICS U' �� Southold, New York 11971 MARRIAGE OFFICER 10 40.-0: Fax (516) 765-1823 �,y®1 ala Fax (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3123-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner RUBINO, FRANK Mailing Address 1 144-22 11TH AVENUE Mailing Address 2 City St Zip WHITESTONE QUEENS NY 11357-0000 Property Address 1 1520 BAILIE BEACH ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 718-767-3759 Tax Map No. section 99.00 block 3 lot 11 .015 Cross Street REEVE ROAD Date Of Last Pump Out 0/00/00 Issue Date: 9/23/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) • OFFICE .OF THE TOWN CLERK ' 'c�VFFU(,��'- Town of Southold �% : ._ �a ' Application No. /c23 Judith T. Terry, Town"Clerk' =. y 53095 Main Road ~ n - $10.00 - Residential Town Hall, qqrT .y�,� . P. O. Box 1179 �' �' e 74 Wil. , h�i � $25.00 - Non-Residential Southold, New York 11971 per® ''t 0�,`, Telephone # 1 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION RECEIVED for SEP 201993 OPERATION PERMIT Southold Town Cleric SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE Sit zo 93 • 'OWNER NAME: raAAik [2 (/g iN • OWNER MAILING ADDRESS: NV - 2 / / / A (i.e bJ 11- G-s10,v-e. Ch u-at tic 1 (3\---7 - OWNER PROPERTY ADDRESS: / Co 9-0 er:-'4/,‘ ?e c c W go, OWNER TELEPHONE NUMBER: X 98 91---v 7/� 7Y'21 s . /I-- TAX MAP NO. : Section aR.L Block- 3 Lot . /1 CROSS STREET: • TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing �� Residential e/ 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.) ---/teL4t) -2t--c/e9-2-%-__ Signature of Applicant RECEIVED BY: .----e 4-0-A° Town lerk's Office DATE: q ` A © ‘ f3 fYFT r JY�