HomeMy WebLinkAboutPapadopoulos it
11 Town Hall, 53095 Main Road
V. O ,�.
�, P.O. Box 1179
i SZ �i�. Southold, New York 11971
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JUDITH T.TERRY -_� ;;,, ����' FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1359-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PAPADOPOULOS, NICHOLAS
Mailing Address 1 P. O. BOX 579
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 335 SUNSET AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 718-726-3781
Tax Map No. section 115.00 block 3 lot 12.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 1/10/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �S�FFO(,1r�'-
Town of Southold - `�1 C' - Application No. / �9
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Judith T. Terry, Town Clerk '
Town Hall, 53095 Main Road _' 1$ -4 1 $10.00 - Residential
p, O. Box 1179 cry . Y; r
�a- , � � :,� �, $25.00 - Non-Residential
Southold, New York 11971 O _: �_ • '�•
Telephone -1Q( 't, .0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
r
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
. DATE /7/0 /76
OWNER NAME: I ' - - Pi ' -
OWNER MAILING ADDRESS: Po oz `j -)�
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OWNER PROPERTY ADDRESS: 3,3 _ _
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OWNER TELEPHONE NUMBER: C27 K) 79-6 -- D 7 ? /
TAX MAP NO. : Section 1`( Blockqr- (.
3 Lot 1`72
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7
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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Signat re of N.plicant
RECEIVED BY: -11-ii--'614--1/4
n Clerk's Office
DATE: d" 7O
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