HomeMy WebLinkAboutPalatianos OFFICE OF THE TOWN CLERK e, �O
Town of Southold ��� �C��
Judith T. Terry, Town Clerk 1 't �, J
Town Hall, 53095 Main Roadczz
P. O. Box 1179
Y� 5� Y�Y 0.a.Y.Y �•,
Southold, New York 11971 Q ® ,. •
Telephone .01 sig1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 516 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: John Palatianos
OWNER MAILING ADDRESS: 22-55 42nd Street
Astoria, New York 11105
OWNER PROPERTY ADDRESS: 425 Marratooka Lane
Mattituck, New York
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OWNER TELEPHONE NUMBER: 718-932-2063
TAX MAP NO. : Section 115 - Block 4 Lot- 3
CROSS STREET: Main Road (Route 25)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
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DATE OF PREVIOUS PUMP-OUT: Unknown
ro• fi it •06. ..04
Judith T. Terry
Southold Town Clerk
DATE: December 3. 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c��FFi7C,l-
Town of Southold Application No.J76
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road = =nk: � Residential
P. O. Box 1179 E' , ` . Non-Residential
Southold, New York 11971 O �
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
RECEIVED SOUTHOLD WASTEWATER DISPOSAL DISTRICT
NOV 251987
APPLICATION
Town Cltrit Southold
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
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Fee $ i\6,'6'0
DATE ��� I /r+
r
OWNER NAME: 0-l-k (34_1_ Ti f ilk®
OWNER MAILING ADDRESS: z-j S Z S'k .
{}S cQ _ n) , l/ _ ) 110c
OWNER PROPERTY ADDRESS: 1-1-7---6- M A (2 i2 1 o 0 i A
OWNER TELEPHONE NUMBER: 11 17 ) 9 3 z - ZO
TAX MAP NO. : Section P C-,ll d Block V. 00 Lot 003, �®
CROSS STREET: /rj g/41 'Pi) �,�,c,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool i% 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.)
ignature of Applicant
RECEIVED BY: 06 -ce .4 �,7
RECEIVED Town rk s ffice
DATE: DEc Q3 TNT.
��,Nr r,4®rk Southold
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,roritToN OF
,,•,',,:e - _ ' - SECTION 7204 OF THE NtW YORK STATE _-�, •
• - _ - EDUCATION LAW - - re
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• V CONES OF THIS SURVEY NAP NOT BEARING MAP
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EMECISSc
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_ LENDIWG INSTITUTION LISTED h-RCON, AND
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NOTE EI EVAT tr;1�.5 >F4OVo' t 1I1 BP,SED ON AN ASSC.JM 1 EI_E'Vf�T"i '�! / . Vit_ _T�~�y
OF 25.0 AT N.E. COP_NE::t.OF LO'•: Ltt~� N:�;: LAND 5:1lr:VEYO 5 :'''J