HomeMy WebLinkAboutPaulides OFFICE OF THE TOWN CLERK ' • eUre-
Town of Southold
Judith T. Terry, Town Clerk • i
Town Hall, 53095 Main Road 8 e=:.; `
P. O. Box 1179 cn '
Southold, New York 11971 �0�- !�
Telephone .alt
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 288 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Miltiades Paulides
OWNER MAILING ADDRESS: 3330 Delmar Drive
Laurel, New York 11948 •
OWNER PROPERTY ADDRESS: 3330 Delmar Drive
Laurel, New York 11948
OWNER TELEPHONE NUMBER: 516-298-5449
TAX MAP NO. : Section 125 Block 4 Lot 15
CROSS STREET: Gina Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: February 1987
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Judith T. Terr
Southold Town Clerk
DATE: April 28, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold �O� `,Q Application No.. ` o
Judith T. Terry, Town Clerk l Residential
Town Hall, 53095 Main Road '" L3
P. O. Box 1179 cn ?Ai ft7 ;' Non-Residential
Southold, New York 11971 O OXY �
Telephone _ '
(516) 765-1801
TOWN OF SOUTHOLD,
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $/0
DATE
OWNER NAME: Ail i 1L T f / p V
OWNER MAILING ADDRESS: <3V 3O DEL-169R p.
LRV P FL &' '_ (1 gN g
OWNER PROPERTY ADDRESS: 53,330 O gl V iq
LtivRe ( Iv ii9gg
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section / 2.5 . 0) Block 01 ,6b0 Lot 6 v970
CROSS STREET: 6' 9). f B
TYPE OF SYSTEM: Septic Tank // New Existing V
Cesspool New Existing
Residential 2/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: ige4
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.)
Signat re of Applican
RECEIVED BY: (4.7
't 1c6;LL.- � - c( -
Town Cle ,k's Office
DATE:
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