HomeMy WebLinkAboutSollecito ®/'
`�
g,rs ` l Town Hall, 53095 Main Road
cf.,toe �`' P.O. Box 1179
®1 `a/��� Southold, New York 11971
JUDITH T.TERRY --•,��iid�r�° 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. 793-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner SOLLECITO, MARIE
Mailing Address 1 PIZZARIELLO, CARMINE
Mailing Address 2 7100 NEW SUFFOLK AVE
City St Zip MATTITUCK NY 11952-0000
Property Address 1 7100 NEW SUFFOLK
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5863
Tax Map No. section 115. 00 block 16 lot 28.000
Cross Street -1343,110e_ _._p
Date Of Last Pump Out 0/00/00
Issue Date: 8/18/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK COFa,r�''
Town of Southold � -�;, C�G�; Application No.
Judith T. Terry, Town Clerk �,h �+ Residential
Town Hall, 53095 Main Road .
P. O. Box 1179 tf t Non-Residential
Southold, New York 11971 �.� 4,06
*-$
Telephone 1 `
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
•
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.1 7 -
Fee $ /O
DATE 8// 7/2.7
OWNER NAME: So L,.LEc //o, /P/ 2.z..4RkziL.L.O
OWNER MAILING ADDRESS: 7/ co /Vet() &)PFOLX deR
c ac_ GU .y, / /`,.i—
OWNER PROPERTY ADDRESS: Snme= As 460V -
OWNER
60V -OWNER TELEPHONE NUMBER: 576 — ca? — Se � 3
TAX MAP NO. : Section //(5 Block av Lot c2g
CROSS STREET: -42''LJE
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New - Existing 1/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7/a
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.)
( SEE gcc,� / e t>6ecv74) .4'
C4,66- /s / % 0/
Si•nature of Applicant
RECEIVED BY: / ' . � _4 .+ : ;7 i
Town I-i 's Office 7
R
DATE:
AUG 18 MaTown Mak Cietk Stet.
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