HomeMy WebLinkAboutMitarotondo OFFICE OF THE .TOWN CLERK
Town of Southold �G
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 4
P. 0. Box 1179• -
Southold, New York 11971 \ p ,,
Telephone fid
(516) -765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation- Permit No. 578 Residential X
Non-Residential
Fee $ 10.00 -
Septic Cesspool X
NAME OF OWNER: AnthonyMitarotondo'
OWNER MAILING ADDRESS: RR #2, 705 Birch Lane
,Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 705 Birch Lane.
Cutchoque, New York 11935
OWNER TELEPHONE NUMBER: None listed
TAX MAP NO. : Section 83 Block 1 Lot 26
CROSS STREET: Duck Pond Road
TYPE OF SYSTEM: -Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential'
DATE OF PREVIOUS PUMP-OUT: 12/86
Judith T.wo Southold Town Clerk
DATE: January 14; 1988 •
k, (TOWN SEAL) ;'
OFFICE OF THE TOWN CLERK '�r�jrF - �
Town of Southold Application No.
Judith T. Terry, Town Clerk
� ..G
Town Hall, 53095 Main Road a V ) Residential
P. O. Box 1179 u-3 +moi Non-Residential
1 $
Southold, New York 11971 0 �o�,�
Telephone ! -
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE I'L-4--8
OWNER NAME: FtatirtfoikAl , i7 oT SOD
OWNER MAILING ADDRESS: &4 2 1-DS
W7 t fbat l
OWNER PROPERTY ADDRESS: Col"-11----
OWNER TELEPHONE NUMBER:
'3
02(0
TAX MAP NO. : Section '; Block Lot
CROSS STREET: U✓(/( Pmd d
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: I0)10
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.)
.S
r
\- uSe., 4� r 1
1' J Signa ure of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: