HomeMy WebLinkAboutSiracusano F Yr' k4'as
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Town Hall 53095 Main Road
P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY 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. 665-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner SIRACUSANO, LOUIS
Mailing Address 1 BOX 264
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 895 NORTH PARISH DRIVE
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3939
Tax Map No. section 71. 00 block 1 lot 9. 000
Cross Street DAYTON ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 4/04/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK, If�FF�
Town of Southold �� - �Q�' Application No. L
Judith T. Terry, Town ClerkC/
Town Hall, 53095 Main Road - :4I Residential
t
P. O. Box 1179 cn ` w* ', Non-Residential
Southold, New York 11971 s ,i
Telephone 0„g .��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
ARCROVED
for
MAR 2 91988 OPERATION PERMIT
TOM Met Sout19@t$ SEPTIC TANK or CESSPOOL
Operation Permit No. (p C 5
Fee
$ (2;-
DATE /74PcI/
OWNER NAME: 4 o cr 5 .$ rrrA C v s //,A/cs
OWNER MAILING ADDRESS: o-
Sou ,46 _ /)(y /177(
OWNER PROPERTY ADDRESS: x'75 fid,rrlf /A4/s-/J /-De r/G--
� c>ci rILI 6 z,9 01( J /17 7
OWNER TELEPHONE NUMBER: :6-7 74 ,
TAX MAP NO. : Section 7 / Block / Lot c
CROSS STREET: / ,d i i o.1"/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: F _ / ' / ✓ Yrs--
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: , ,, y„ 1
(4.44-
,/f' Town !