HomeMy WebLinkAboutPalumbo cis
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u` Town Hall, 53095 Main Road
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r^c Southold, New York 11971
JUDITH T.TERRY k ` k xN 019. FAX(516)765-1823
TOWN CLERK TELEPHONE(516)7654801
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. 1021-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PALUMBO, FRANK N. & LOUISE O.
Mailing Address 1 187-17 87TH ROAD
Mailing Address 2
City St Zip JAMAICA NY 11432-0000
Property Address 1 6570 BAY AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 718-454-8134
Tax Map No. section 104.00 block 5 lot 6.001
Cross Street HAYWATERS ROAD
Date Of Last Pump Out 2/11/88
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Issue Date: 2/15/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I
OFFICE OF THE TOWN CLERK cOFOUr
Ca
Town of Southold Qli Application No. /7 -J
Judith T. Terry, Town Clerk ,:;V4'-'4.e �') Residential
Town Hall, 53095 Main Road a .
P. O. Box 1179 cry < ' s= 'aa� `
up.
� Non-Residential
Southold, New York 11971
Telephone
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 2- LJ
•
•
OWNER NAME: FR-40 1.-- 4/ 4- PA/_vnBo
OWNER MAILING ADDRESS: /8 -17 '7 r' i20,41)
3-4-H 1W e44- ' Al•Y
OWNER PROPERTY ADDRESS: 6570 BAY AV JL
i
r
OWNER TELEPHONE NUMBER: 7113 1133 - f3 ,
TAX MAP NO. : Section 10 Block Lot 6
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
/
Cesspool �/ New Existing
Residential / Non-Residential
DATE OF PREVIOUS PUMP-OUT: 0170- 88
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.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
Bey
A r5, -c-- $ a-
140.156
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