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HomeMy WebLinkAboutPanzarino / ♦ ���,,, ',,:� ��FfOIKc ® = •JUDITH T. TERRY ; Town Hall, 53095 Main Road TOWN CLERK ►►� P.O. Box 1 179 REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971 Fax (516) 765-1823 MARRIAGE OFFICER ® ®� • ',y®11D � Fax (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3004-R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool New Existing X Name Of Owner PANZARINO, ANTHONY AND MICA Mailing Address 1 800 STROHSON ROAD Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 800 STROHSON ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-6712 Tax Map No. section 103.00 block 10 lot 23.000 Cross Street LITTLE NECK ROAD Date Of Last Pump Out 0/00/00 Issue Date: 4/20/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) "' OFFICE OF THE TOWN CLERK . �COFOCA-��- _ / / C' Application No..©0 ! Town of Southold �� �G ; pp �" Judith T. Terry, Town Clerk % A--: , 1'-'' , Town Hall, 53095 Main Road P =4ac $10.00 - Residential cn ', ` :., $25.00 - Non-Residential P. O. Box 1179 T� '- '� ` Southold, New York 11971 O*04;" e' ��1 Telephone YN '� • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION k _`__ APrrtpvety for OPERATION PERMIT APR 1 1W3 SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • • DATE �/Z,L(' if //cCf e/11 iii / 7 OWNER NAME:' 4/(fT/ 7 f�J,�,4,� /jC' 0 OWNER MAILING ADDRESS: -6J d,57Z /7 5 /C/ � _ 0 -C -/Z - , ti , y _ // s- OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: 7427 677z- , J TAX MAP NO. : Section ,1-',0__. .. Block /0 Lot _.2-3- . . CROSS STREET: / /---/{1 -/OZ-6-4_. / TYPE,OF—SYSTEM: -==Septic-Tank- Y--- - New Existing X Cesspool 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.) _ /17_.ztn. 4 --7 Signature of Apuicant RECEIVED,- BY: .., . . - , .�- — ! ` - _ - - - - - _-_ -_- ____ _ _ ._ _ Town Cler ''s Office DATE: ' '-1-",' 1 / ' Gl'3 -- - - - I J L \* t 6 I i I rP,� H-56 ,u ►2,