HomeMy WebLinkAboutPaliouras 0.1 i1 f UL
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P.O. Box 1179
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6,JUDITH T.TERRY ®� IL��!� TELEPHONE
[O VN CLERK (516) 765-1801
REGISTRAR OE VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 783-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PALIOURAS, ANDREAS
Mailing Address 1 P. O. BOX 434
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 COUNTY ROUTE 48
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-765-9277
Tax Map No. section 74. 00 block 4 lot 9.000
Cross Street PAULS LANE
Date Of Last Pump Out 0/00/85
Issue Date: 8/10/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �'=
Town of Southold Q CS ` Application No. ?L3
Judith T. Terry, Town Clerk �'� Residential
Town Hall, 53095 Main Road y .
P. O. Box 1179 v' Non-Residential
Southold, New York 11971 ® ®,
Telephone 0.( HP ?
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. l b
Fee $ /O
DATE g/ /dhr
OWNER NAME: flfrU Oo E j S 0 aqL /6 oefi S
OWNER MAILING ADDRESS: R. 0. / ( ( () 3C/ e00 q- g-
pE.CUA/tc
OWNER PROPERTY ADDRESS: Divi L
OWNER TELEPHONE NUMBER: 'Xc` c'a /7
TAX MAP NO. : Section 6' 4/ Block d Lot 06 9.
CROSS STREET: P/ U L JS LII
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 3 ye S
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.)
. ' ' I ' _
Sig a ure of Applicant
RECEIVED BY:
Town Clerk's Office
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DATE:
AUG 1 O 1989
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