HomeMy WebLinkAboutQuatroche �,; Town Hall, 53095 Main Road
�- • P.O. Box 1179
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* Southold, New York 11971
JUDITH T. TERRY ������ t����//, / 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. 1095-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner QUATROCHE, VINCENT J. & EDNA T
Mailing Address 1 12 SUTTON PLACE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 12 SUTTON PLACE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0017
Tax Map No. section 33.00 block 4 lot 69.000
Cross Street SUNSET LANE
Date Of Last Pump Out 0/00/00
Issue Date: 5/01/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK /c�drOur
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Town of Southold s . C0� Application No. /6 95-
Judith T. Terry, Town Clerk .� cG .I Residential
Town Hall, 53095 Main Road
O -��,'�-�`+ µrd�
P. O. Box 1179 w �+.* i , Non-Residential
Southold, New York 11971 O a=4.-1M•;0.
Telephone : 1 4 0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE- PJB/L> / /9
OWNER NAME: gl/&/1/2— E /l/�f 9r�L,¢- o t
OWNER MAILING ADDRESS: /c2 6'0-17A1
/v_L/. // 5'SL'L
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 4-7C Q(9( , •
TAX MAP NO. : Section Block Lot
CROSS STREET: 577i pZ1fti �,, cP���4vsv 2. ,94/4-Y (TF)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool y- New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,n79&-, / /' /RP'?
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
srLANdistance, approximately, to building and closest road.)
Oily '4.0'
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9‘6ey ,
Sig ture of Applicant
RECEIVED BY: �,,
Town Jerk's Office
DATE:
WAY In 1989
Town _Clut ; 7; ,�