HomeMy WebLinkAboutSalice JUDITH T. TERRY
`' t '�� ��`�' Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS / Southold, New York 11971
MARRIAGE OFFICER :� ys� - r 7 I Fax (516) 765-1823
-s ;' ; 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. 1583-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner SALICE, PHILLIP
Mailing Address 1 244 WOODHULL AVENUE
Mailing Address 2
City St Zip PORT JEFFERSON NY 11776-0000
Property Address 1 1945 BAYVIEW AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-367-9610
Tax Map No. section 106.00 block 6 lot 37.000
Cross Street NORTH DRIVE
Date Of Last Pump Out 0/00/00
,000
Issue Date: 1/17/91 Judith T. Terr
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c\\VFU(,('�'-
Town of Southold CSG- Application No. /5-83
Judith T. Terry, Town Clerk
� `� ` �l $10.00 - Residential OC
Town Hall, 53095 Main Road .
P. O. Box 1179 CJ7 -x.a s` a- u- `� }
f•�= � $25.00 - Non-Residential
Southold, New York 11971O*0'41'•
® as`? 0�°f
Telephone ' 0l N�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. -
Fee $ /0..0o
DATE ////9 0
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'OWNER NAME: '} f/1l-L,P
OWNER MAILING ADDRESS: Z'-/y /.vOoa1Nv�L ,ya/c,
?aR 1 �Er^FE�SaN ioa� N/ J/ 77(.6
OWNER PROPERTY ADDRESS: / 7'/1 Lam/ ����, ,g✓�
OWNER TELEPHONE NUMBER: 3�7 _ ?CIO
TAX MAP NO. : Section /0(0 Block Co Lot 37
CROSS STREET: po<zTy �jzovC
TYPE OF SYSTEM: Septic Tank ;X New (> Existing
Cesspool New Existing
Residential K 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.)
Signature of Applicant
so+ ,) .H v#SnalL6
RECEIVED BY:
Town Clerk's Office
DATE:
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