HomeMy WebLinkAboutSignorelli JUDITH T. TERRY a , u ;l. Town Hall, 53095 Main Road
TOWN CLERK ' -.� 1 P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS $ ` Pwa Southold, New York 11971
MARRIAGE OFFICER -�1's ' -- ✓ w j Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1619-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SIGNORELLI, PETER & MARGARET
Mailing Address 1 P. O. BOX 372
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 260 EASTWARD COURT
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-11491
Tax Map No. section 115.00 block 7 lot 3.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
•
Issue Date: 1/17/91 Judith T. Terri
Southold Town Clerk
(TOWN SEAL)
• .
OFFICE OF THE TOWN CLERK '' FOU-
Tciwn of Southold Q ' Application No.
Judith T. Terry, Town Clerk � $10.00 - Residential (/
'11 Town Hall, 53095 Main Road a 4 :'4> .
p. O. Box 1179
z $25.00 - Non-Residential
Southold, New York 11971 O.,T 1,6%
Telephone
Telephone Q1 "
(516) 765-1801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE e g , jgr
'OWNER NAME: Pe 7L87 r J • S 1 !') P- e -.4//
2 Coo
OWNER MAILING ADDRESS: 150)C ;?7,,,/-"LA,57'y{iy412 7Y
,49,/MT 17 TzJGK My, 11 q.
OWNER PROPERTY ADDRESS: 5-1,0 416" - - - - -
OWNER TELEPHONE NUMBER: .!f/c fS' , %/
TAX MAP NO. : Section Block Lot 8
CROSS STREET: /V/j.) d.{ 'Ro Pt (AL Y.5;172-,Z-6)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool I New Existing
Residential VI 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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Signatu, e pplicant
RECEIVED BY: C..0Q_et__>
Town 'Clerk's Office
DATE: / / 7— "
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