HomeMy WebLinkAboutPumillo OFFICE OF THE TOWN CLERK ' F�
Town of Southold �Qc��F COG
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Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 4• �r
P. O. Box 1179 • i�� ''� ' ' `
Southold, New York 11971 ‘- `01!1';''"''S
Telephone _ jj�� • 0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
_ SEPTIC TANK or CESSPOOL
Operation Permit No. 509 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Jody and Christine Pumillo
OWNER MAILING ADDRESS: Box 182A
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Pat Lane
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-5932
TAX MAP NO. : Section 114 Block 10 Lot 10
CROSS STREET: Deer Drive - Mark Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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t.> .
Southold Tow 'fClerk
DATE: December 2, -1987
•
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK
Town of Southold , Application No. 5.°YJudith T. Terry, Town Clerk . s f
Town Hall, 53095 Main Road '` G I Residential
P. O. Box 1179 En eh Non-Residential
Southold, New York 11971 O ®
Telephone e/ N.a® ��•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. n
Fee $ /0.500
DATE if/- :)513/7
•
OWNER NAME: q U() t/ - elki5 / iA��= U�;C.� 1 C�
7
OWNER MAILING ADDRESS: 130GX( I O2 P -
m FT?TUC1c.
OWNER PROPERTY ADDRESS: PAT- L Y-1 N C
i A ;Tuck_
OWNER TELEPHONE NUMBER: ciA 8- 593 a_
TAX MAP NO. : Section // V Block i° Lot / Q
CROSS STREET: �EI�. /Z )U / i k ,(C)).geL
TYPE OF SYSTEM: Septic Tank New Existing \f
Cesspool New Existing Ni
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 10 —eF4
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.)
104/
JA-nature of Applicant
RECEIVED BY:
REan ewn Clerk's Office
DATE: DEC 0219B7
'Rom eterk Southold
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