HomeMy WebLinkAboutPosillico 'i�r
OFFOLt
JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK ; •
y P.O. Box 1179
08. t Southold, New York 11971
REGISTRAR OF VITAL STATISTICSL Sig Fax Fax(516) 765-1823
MARRIAGE OFFICER o�® � Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER vg," I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3488-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner POSILLICO CONSTRUCTION CO.
Mailing Address 1 31 TENNYSON AVENUE
Mailing Address 2
City St Zip WESTBURY NY 11590-0000
Property Address 1 2495 KERWIN BLVD.
Property Address 2
City. St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-333-0666
Tax Map No. section 53.00 block 4 lot 44.034
Cross Street SAGE SPUR
Issue Date: 7/16/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
l •
OtFICE OF THE TOWN CLERK IFO
Town of Southold �� CQ Application No. 3 I
Judith T. Terry, Town Clerk r4
Town Hall, 53095 Main Road -4- I $10.00 - Residential
P. O. Box 1179 - ,`;' �' $25.00 - Non-Residential
Southold, New York 11971 O /�`
Telephone c'"(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 7X6/6
OWNER NAME: P:)-57Z-Z.-/C--0 w s7 t-c7/67✓ .
OWNER MAILING ADDRESS:
• Vl7es1L' , ,IVY j/S ?O
OWNER PROPERTY ADDRESS : 2495 / rir 51✓1
OWNER TELEPHONE NUMBER: 3 33 -6564
TAX MAP NO. : Section 6'3 Block 9 Lot 9V° 3C1
CROSS STREET: Sa. ' e $ v v
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential Non-Residential
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 r= of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
6 ,XL- - /`/3---3