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HomeMy WebLinkAboutMeskouris JUDITH T. TERRY . 7. Town Hall, 53095 Main Road P.O. Box 1179 TOWN CLERK ® U-ri � REGISTRAR OF VITAL STATISTICS .� Southold, New York 11971 M� O i �4r Fax (516) 765-1823 MARRIAGE OFFICER ® � sl Fax (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1852-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner MESKOURIS, PETER Mailing Address 1 69-08 DITMARS BLVD. Mailing Address 2 City St Zip JACKSON HEIGHTS NY 11370-0000 Property Address 1 1775 POINT PLEASSANT Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-9463 Tax Map No. section 114.00 block 1 lot 6.000 Cross Street WESTPHALIA Date Of Last Pump Out 0/00/00 Issue Date: 2/26/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) � •0 a iii O �Fr�: '1 THE TOWN CLERK Fik Town of Southold n. CQ Application No. / Judith T. Terry, Town Clerk , �` � k; �► f� Town Hall, 53095 Main Road o vV$10.00 - Residential � � ��.A P. 0. Box 1179 ' � � ` $25.00 - Non-Residential Southold, New York 11971 O'44-4'A;" 1+'� �O� ��` Telephone = 1 y► '� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • • DATE . �'�C7-- Z OWNER NAME: Terriz M r tLo( cCLIC OWNER MAILING ADDRESS: X9--0 ? 17-mptts ? LL)) j�c�WI hoc S 7't Y. 11310 OWNER PROPERTY ADDRESS: l 1 35" P©Icz-P+sriwr_ nr1r4rt' a oi-u tz [ —J. H 45 OWNER TELEPHONE NUMBER: 516 4`I ? 1146 TAX MAP NO. : Section 1 t 4 Block 1 Lot C. CROSS STREET: �i f 1 - OCl 1A)FS1PHcIL) / TYPE OF SYSTEM: : 'Septic}Tank : New Existing Cesspool New Existing •• Residential ' 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.) Signature of Applicant RECEIVED BY: REClerk's 0 fice -- _ .•. • ,- • DATE: . FEB 24199? _ lam Clerk Southold