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HomeMy WebLinkAboutMoisa (2) r. g�FFO(�� ,,••,��® OG JUDITH T.TERRY ������ y1 Town Hall, 53095 Main Road • TOWN CLERK ; y 2 ; P.O.Box 1179 r. �� Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 1 MARRIAGE OFFICER �* a 'i� Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER O.( * � . •d Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER •�� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3460-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner MOISA, JOSEPH Mailing Address 1 P. O. BOX 815 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 WESTVIEW DRIVE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-4395 Tax Map No. section 139.00 block 1 lot 1 .000 Cross Street BROWER ROAD Issue Date: 4/24/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) 4OF.FfC2 OF T -lE TOWN CLERK 'S��FD(,� _ Town of Southold , O�Q CQG:� Application No. 3 .0 Judith T. Terry, Town Clerk • *O. Town Hall, 53095 Main Road • -< $10.00 - Residential P. O.' Box 1179 cn `' $25.00 - Non-Residential Southold, New York 11971 O`�f Or/ *-$ Telephone Q( • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $\©•. O- • - DATE OWNER NAME: OWNER MAILING ADDRESS: p _ j \t'S. OWNER _PROPERTY ,ADDRESS: 4� � NCN. \\Q\5a OWNER TELEPHONE NUMBER: \ c) ' `�����`�q� • • TAX MAP NO. : Section\%c -\ - \ Block Lot • CROSS STREET: c3i. _ate TYPE OF SYSTEM: Septic •Tank • v • - New Existing V Cesspool New Existing V Residential V 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.) ( - PTit G Signature of Applicant - RECEIVED BY: - " %. Town. Clerk's Office ,• DATE: _ ' - S'C ak fiociosse \s‘pvk \ ., S;p7;'es 7fifilh S'f-P(664 c ess rod