HomeMy WebLinkAboutPaliouras • Y,
�• '
7,7s .
JUDITH T.TERRYi ® :; �, ` Town Hall,53095 Main Road
TOWN CLERK kr ;V
'^ P.O.Box 1179
' �
REGISTRAR OF VITAL STATISTICS ® Iv;.' r '�' ` Southold,New York 11971
��
MARRIAGE OFFICER V f �� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER1� `7,s' 0di Fax
(516)765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3339-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner PALIOURAS, RIZOS
Mailing Address 1 38-07 DITMARS BOULEVARD
Mailing Address 2
City St Zip ASTORIA NY 11105-0000
Property Address 1 65795 NORTH ROAD
Property Address 2 P. O. BOX 393
City St Zip GREENPORT NY 11944-0393
Owner Telephone No. 718-545-7417
Tax Map No. section 40.00 block 2 lot 6.004
Cross Street MOORE'S LANE
Issue Date: 5/19/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
Y �~ • •ice
OFFICE OF THE TOWN CLERK cOFOU(
��=
Town of Southold CQG Application No. 3337
Judith T. Terry, Town Clerk • k y
Town Hall, 53095 Main Road a , ; $10.00 - Residential
P. O. Box 1179 cn - i r $25.00 - Non-Residential
Southold, New York 11971 O 0*.$
Telephone *Q( * %- '/
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE I ? qs
OWNER NAME: RI 70S I
OWNER MAILING ADDRESS:3e`O7 p,*,„„„tx,L)
OWNER PROPERTY ADDRESS: 6157 f 0R -AbActi1 Po s x
P�P_>L►PoR`t � nr,Y, 1t9Cid - ®3y,7
OWNER TELEPHONE NUMBER: TO - Y'S-- 741/7
TAX MAP NO. : Section: 17[0 Block 6 Lot £ "
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
• , Cesspool New Existing
Residential V Non-Residential
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.)
/Z / PGC le
Signature of Alt/
licant
RECEIVED BY:
Town Clerk's Office _ _ -
DATE: