HomeMy WebLinkAboutPizzarelli •
OFFICE OF THE TOWN CLERK • .c0FQUri;
Town of Southold -
Judith T. Terry, Town Clerk :1`tot.
Town Hall, 53095 Main Road i� ~ �
P. 0. Box 1179 f+ y :�:
Southold, New York 11971p�-® " �- *'
Telephone 2?j
(516) 765-1801
•
- TOWN OF SOUTHOLD
• SOUTHOLD WASTEWATER -DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 414 Residential x
Non-Residential
- Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Peter D. Pizzarelli
OWNER MAILING ADDRESS: P.O. Box 214
Peconic, New York 11958
OWNER PROPERTY ADDRESS: Indian Neck Lane
Peconic, New York
OWNER TELEPHONE NUMBER: 516-734-5976
TAX MAP NO. : Section 98 Block 5 Lot 14.3
CROSS STREET: Robinson Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New ExistingX
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terry
Southold Town Clerk
DATE: August 25, . 1987;
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'S�FF0,,��
Town of Southold % - eQ-'; Application No. v47
Judith T. Terry, Town Clerk : - ,s
Town Hall, 53095 Main Road 4 -4 I Residential
cars aM.I.,- t
P. O. Box 1179 � , �. Non-Residential _
Southold, New York 11971 O ,•�`
Telephone .( IN V
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
OJ
Fee $ /0.
F/02 -7
7
DATE
OWNER NAME: Ra":46-'72_ ,. )32-Z- 4-11-tEktf
OWNER MAILING ADDRESS: /0 13 x 417
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OWNER PROPERTY ADDRESS: —T/v-v/h---h/ Gl'//tI c f 4 4,-/A."----
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OWNER TELEPHONE NUMBER: 2 3 Cf - 51 76
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TAX MAP NO. : Section di, `' J� Block Lot / 9/, 3 •
CROSS STREET: e 2'1%z a. , e- .
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool A / New Existing IV-
Residential ,/f 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.)
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Signat9
r of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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