HomeMy WebLinkAboutPanella 014°egf 01.10.1
JUDITH T. TERRY Z
Town Hall, 53095 Main Road
TOWN CLERK • 2C P.O. Box 1179
REGISTRAR OF VITAL STATISTICS `, Southold, New York 11971
MARRIAGE OFFICER �� Fax (516) 765-1823
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—_ � 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. 1788-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PANELLA, RALPH
Mailing Address 1 1 DICKINSON AVENUE
Mailing Address 2
City St Zip YONKERS NY 10703-0000
Property Address 1 TAKAPOSHA SHORES ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 914-423-2011
Tax Map No. section 87.00 block 6 lot 9.000
Cross Street - MAIN BAYVIEW ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 10/11/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c,VWFOCA-
Town of Southold �� "` C&G': Application No. 78.k
Judith T. Terry, Town Clerk`*
� CIA � � $10.00 - Residential
Town Hall, 53095 Main Road t°
p. O. Box 1179 u' ., #';"` �i $25.00 - Non-Residential
Southold, New York 11971 �%+ 0 ��'
Telephone Zb ��
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /D
DATE /®/7/pj
OWNER NAME: ?RIS' P/44ELL.. -
OWNER MAILING ADDRESS: ) GKtp-ISON 415 .
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OWNER PROPERTY ADDRESS: 7 Sne ,ZQSc�� cf941141-TQ 9�
OWNER TELEPHONE NUMBER: 9) N—
TAX MAP NO. : Section g 7 Block Lot 9
CROSS STREET: _ M ,4110 'B41 IJ/EVJ
TYPE OF SYSTEM: Septic Tank ✓ New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 44...
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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.)
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Signature of Applicant
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RECEIVED BY: , 5.rpric
Towk s Office ? r �PO�
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DATE: zD�
RECEIVED - — f4®us t.
OCT 1 '; 1f'4l
Town Clerk Southold Al/ N va i b e rs 9-a-
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