HomeMy WebLinkAboutPetrucci JUDITH T. TERRY • } Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK v u �p
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER 19 Fax (516) 765-1823
-4,4744i
�® Telephone (516) 765-1801
u.4,„.OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1958-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner PETRUCCI, BRUCE AND BARBARA
Mailing Address 1 2140 BAYSHORE ROAD
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 395 BURGUNDY COURT
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-477-9534
Tax Map No. section 51 .00 block 3 lot 3.013
Cross Street SOUND VIEW AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 8/17/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
;OFFICE OF THE TOWN CLERK 1cvFF0tire- /
Town of Southold , - CQ ' . Application No. ! S‘57
Judith *. 'Terry, Town Clerk
Town Hall, 53095 Main Road ° � $10.00 - Residential
P. O. Box 1179 VX 1 "u �` $25.00 - Non-Residential
Southold, New York 11971 O � f,`�O�'•'�`
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE i5 - ata.
OWNER NAME: 'AA Ye
OWNER MAILING ADDRESS: ft l4 a' shoYYe. QOQ ,
GrQ nporA- 1 Iv . \1.
OWNER PROPERTY ADDRESS: 3q5 BUY WdAi _ o_y- i
1\1\1 \ \f�
OWNER TELEPHONE NUMBER: 16--1-911-QS314 Or ib5 -Q3;1.1
TAX MAP NO. : Section 5O Block 3 Lot 3. 0\ 3
CROSS STREET: So,i,n \
TYPE OF SYSTEM-: Septic Tank V- New '' Existing
Cesspool ✓ New ' Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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
RECEIVEDb(1/a4.-BY:
own Clerk's Office
DATE: ,r7(
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