HomeMy WebLinkAboutSavona JUPf,1fTH T. TERRY ; `: Town Hall, 53095 Main Road
TOWN CLERK
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P.O. BOX 1179
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REGISTRAR OF VITAL STATISTICS CP * �1 Southold, New York 11971 •
MARRIAGE OFFICER yQ O� , Fax (516) 765-1823
,y®1 �1� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2070-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SAVONA, JOHN L.
Mailing Address 1 P. O. BOX 196
Mailing Address 2
City St Zip MT. SINAI NY 11766-0000
Property Address 1 3295 PINE TREE ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-744-9879
Tax Map No. section 104.00 block 3 lot 10.000
Cross Street SKUNK LANE
Date Of Last Pump Out 0/00/00
Issue Date: 3/08/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE •OF THE TOWN CLERK FD
Town of Southold Application Nom'° V
. I
Judith T. Terry, Town Clerk .
t, $10.00 - Residential
Town Hall, 53095 Main Road
P. 0. Box 1179 �t> r ' ► : $25.00 - Non-Residential
Southold, New York 11971 Off '
Telephone : .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - -- — - -
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /v. "It
DATE 3/4/913
OWNER NAME: d 0 `-{ L . g,A .Jo p A
OWNER MAILING ADDRESS: p. 0, 1.3 b )C g
tla I Alre 9 .ki@ f 17�o
- - OWNER -PROPERTY ADDRESS: -C,aP: C3Ay Ak iv teL LA N6
{imE r I CG RO , CvT 4uC Prc ,
OWNER TELEPHONE NUMBER:'741-1 -q -7 3L! - 6, 2..3 /
TAX MAP NO. : Section Block Lot
AYE AVE'
CROSS STREET:(eaRQ ) SkuNk- //iiE P TR e' RP
TYPE OF SYSTEM: - -Septic` Tank - New Existing 1--/'
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 11/111 ' /1-2--
LOCATION MAP: Must be attached heretobefore permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.) - _
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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