HomeMy WebLinkAboutMinardi OFFICE OFTHETOWN CLERK 'cwFFOLke►'
Town Of Southold �Q OG
Judith T. Terry, Town Clerk (4-4
Town Hall_, 53095 Main Road `
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P. O. Box 1179 ��cn �`;
Southold, New York 11971 '\p ® ``-4,4 •�
Telephone = 01
(516) 765-1801 _
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 456 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Jennie Minardi
OWNER MAILING ADDRESS: P.O. Box 332
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Grand Avenue
Mattituck, New York
OWNER TELEPHONE NUMBER:. 516-298-8854
TAX MAP NO. : Section 107 Block 3 Lot
CROSS STREET: Westview Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New - Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: March 21, 1986
JawdiU't T. 'cry
Southold Town Clerk
DATE: October 8, 1987
(TOWN .SEAL)
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OFFICE OF THE TOWN CLERK - �COFOC,r�.=
Town of Southold �% CQ Application No. ' ef.5"�
Judith T. Terry, Town Clerk .� 0-: +g', Residential
Town Hall, 53095 Main Road ;Y;
P. O. Box 1179 LI" '- . y1 ` , - Non-Residential
Southold, New York 11971 O0\-- e$
Telephone 1 4
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(516) . 765-1801
, TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION -
for `
OPERATION PERMIT
SEPTICTANK or CESSPOOL
Operation Permit No.
Fee $ /D'' '
. , ,
DATE jolt/ r
,-,
OWNER NAME: • N N'1 f ,
• fJOWNER MAILING ADDRESS: / O 52() 3 61141 /1E) ,
/4 A fn ro c /9 N'/' f/ 31- 2- . .
OWNER PROPERTY ADDRESS: SA ifi
OWNER TELEPHONE NUMBER: � / 1- fgi
TAX MAP NO. : Section /' 9.,_,,0 [ -) Block /0 7 -,-`" Lot 3r '
CROSS STREET: o-e .i-) CA.,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool /,..-- New Existing
Residential Non-Residential
- DATE OF PREVIOUS PUMP-OUT: / 2J f
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-#.I , 8 J,a
RECEI E flown f erk's O ice
DATE: off O8198 '
Town Clerk Southold -
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