HomeMy WebLinkAboutPrieto 149
�, if Town Hall, 53095 Main Road
01C��y�O ®N 11 P.O. Box 1179
�!v,0/ t = Southold, New York 11971
JUDITH T.TERRY 1�®_,i� -
• TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3578-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner PRIETO, DOLORES
Mailing Address 1 P. O. BOX 1274
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 2750 MINNEHAHA BLVD.
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-4641
Tax Map No. section 87.00 block 3 lot 44.001
Cross Street OPECHEE AVENUE
Issue Date: 1/21/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �FFR - '
Town of Southold ' ���; • Application No. 3 S
Judith T. Terry, Town Clerk , r �`� $10.00 - Residential
Town Hall, 53095 Main Road 1 -
P. O. Box 1179 w F ' ' i $25.00 - Non-Residential
Southold, New York 11971 0 • �0 ��'
Telephone •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE i -AA 02 / . / 99Z
OWNER NAME: Do)-®/ES FA.Vro
OWNER MAILING ADDRESS: K /61.-7+
11✓t 0-b� OU Y 1 / 1/
OWNER PROPERTY ADDRESS: I 7.6-75 -/'-! l/✓/J1t/T /-3,14/,/)
SOS- n> ' . /1971
OWNER TELEPHONE NUMBER: -6-16 7 6 4U/
TAX MAP NO. : Section e o Block-3 444 if Lot
CROSS STREET:- . OPEc/ii-EG;— ,4de,
TYPE OF SYSTEM: Septic ,Tank New Existing
Cesspool New Existing I/'
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.)
Signature of Applicant
RECEIVED BY: `e
- Town CI r c's Office - •
DATE: / / f
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