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U' �� Town Hall, 53095 Main Road
O ��, P.O. Box 1179
4*ei * ��orI/ Southold, New York 11971
JUDITH T. TERRY -�,,,, I" TELEPHONE
TOWN CLERK (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. 1073-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PANAGIOTOPOULOS, BESSIE
Mailing Address 1 20-33 48TH STREET
Mailing Address 2
City St Zip ASTORIA NY 11105-0000
Property Address 1 87 BEACH ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 718-932-6835
Tax Map No. section 43.00 block 4 lot 17.000
Cross Street LANDING LANE
Date Of Last Pump Out 0/00/00
Issue Date: 4/05/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ,•Fp�,r''-
Town of Southold ��' CQ T. Application No. /O 7.3
Judith T. Terry, Town Clerk ,_' =< ar :') No./O
Main Road a a: ..r----/* :'� Residential �/
Town Hall, at
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P. O. Box 1179 �.,� ♦ Non-Residential
Southold, New York 11971 O � ���•1`,
Telephone j ' '.
(516) 765-1801
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation PermitxxNo. /0 ,i 3
Fee $ /2) C90
DATE H A 2C14 l (1 ?
OWNER NAME: BCSS/E P3ijill 61ioTb •F oOlb s
OWNER MAILING ADDRESS: 06. 33 *Pe e sr
A5Tb2 i /u / / it o.i
OWNER PROPERTY ADDRESS: C7 BEACH 2_b
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OWNER TELEPHONE NUMBER: (lig) 73�. 68-3c (570 4L770737 #
TAX MAP NO. : Section ' '1"..g Block 1/ Lot / 7 ,
CROSS STREET: LAaND/A/6 LANE
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool •.,-- New Existing ''�
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Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: Nel/ i:2 Pu k/PEZ 00 /
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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RECEIVED BY: C c-CLc., j
Town C erk's Offi e
DATE:
APR 05 1989
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