HomeMy WebLinkAboutSpitaliere JUDITH T. TERRY : SC. Town Hall, 53095 Main Road
TOWN CLERK •
Gra �Z+ P.O. Box 1179
itrsREGISTRAR OF VITAL STATISTICS � Southold, New York 11971
� � Fax (516) 765-1823
MARRIAGE OFFICER ' Cee ®/3 . Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3272-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner SPITALIERE, JOSEPH C.
Mailing Address 1 9 NOEL PLACE
Mailing Address 2
City St Zip SMITHTOWN NY 11787-0000
Property Address 1 3735 PARADISE POINT ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-724-6220
Tax Map No. section 81 .00 block 1 lot 16.003
Cross Street NORTH BAYV I EW ROAD
Issue Date: 10/26/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK oSVFFf(,r
Town of Southold , �� CQG Application No c
Judith T. Terry, Town Clerk .
- Town Hall, 53095 Main Road
11:1114 �"" I $10.00 - Residential C/
aS
P. O. Box 1179 "' ;. ` $25.00 - Non-Residential
Southold, New York 11971
Telephone : .(
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ///,0 7 19
OWNER NAME: G`�s" )I /.."�246•1l -
OWNER MAILING ADDRESS: 7 /wet /'L. 3.74 ''17 7
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-- • • OWNER PROPERTY ADDRESS: 37 TS- ?A •Pi,a-/,o
5;5/e ,d4,, /c/
OWNER TELEPHONE NUMBER: C$ ) 72-q --•- -2„ Z v r
TAX MAP NO. : Section 51 Block / Lot 3
CROSS STREET: jU '71-1 ,&7fr/„9,�
TYPE OF SYSTEM: Septic Tank e../- New Existing
Cesspool New Existing
Residential j Non-Residential
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.)
I ignyt'ure of Applicant
RECEIVED BY: / LL t
Town Clerk's Office
DATE: / /9
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