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HomeMy WebLinkAboutPetrucci 4r - OFFICE OF THE TOWN CLERK '��FFncrrt;- Town of Southold - OG Judith T. Terry, Town Clerk • k Town Hall, 53095 Main Road P. 0. Box 1179 1 cn ` ' 4 Southold, New York 11971 ti Q^ '` fi# •�, Telephone = 1lye 11°- (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 186 Residential x Fee $ 10.00 Non-Residential Septic Cesspool X NAME OF OWNER: Bruce and Barbara Petrucci OWNER MAILING ADDRESS: 2140 .Bayshore Road Greenport, New York 11944 OWNER PROPERTY ADDRESS: 2140 Bayshore Road Greenport, New York OWNER TELEPHONE NUMBER: 516-477-9534 TAX MAP NO. : Section 53, Block 4 Lot 25 CROSS STREET: Kerwin Blvd./Route 25 TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing x Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: Unknown Judit T. Terry Southold Town Clerk DATE: December 22, 1986 (TOWN SEAL) .. „� OFFICE OF THE TOWN CLERK c.OFQ Town of Southold �� • CQ Application No. a _ Judith T. Terry, Town Clerk . � �', �► Town Hall, 53095 Main Road 4.;; � .�,; � Residential`' � Non-ResidentialP. O. Box 1179 Southold, New York 11971 O �� Telephone _ rIt (516) 765-1801 Q( • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. /S6 Fee $ 10, DATE (DR I I R O OWNER NAME: B ru ,Cu '- ' b �l-&' CJS- P,?_ OWNER MAILING ADDRESS: cQ I ` o OWNER PROPERTY ADDRESS: L-Cl./r1-Q.- 044-) u-k---- OWNER TELEPHONE NUMBER: 6P tp- LM — q S 3 4 TAX MAP NO. : Section 5-3 Block Lot 02 S CROSS STREET: KPfuJ i o MVC. . /9C 05- TYPE cTYPE OF SYSTEM: Septic Tank 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 RECEIVED BY: Cf-ty,. .� Town I rk'sdOffice RECEIVED DATE: DEC 2 2 1096 Town Clerk Southold 2- c tL SS?oot S ` ..\., /_0, , . , , , , - vof 1 G!,IRA (( . / LI N ©US�L _ S cribN GS3) A(oCyc o4�� Z) o �/}:/ HOR(L20 c©� as(r2�ki�Po2fi7 il ;. t,' ' :. ' , ' 1 3ai v ' r erf-S N o a'c GZ 0. 1