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HomeMy WebLinkAboutNovey °µfK Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 JUDITH T.TERRY FAX(516)765-1823 TOWN CLERK TELEPHONE(516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1197-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner NOVEY, JOSEPH --------- -------------------- Mailing Address 1 VASILAKIS, GEORGE AND FLORENCE ------------------------------ Mailing Address 2 P. O. SOX 1206 ------------------------------ City St Zip SOUTHOLD NY 11971-0000 -------------------- -- ---------- Property Address 1 21625 SOUNDVIEW AVENUE ------------------------------ Property Address 2 ------------------------------ City St Zip SOUTHOLD NY 11971-0000 -------------------- -- ---------- Owner Telephone No. 516-765-1170 Tax Map No. section 135.00 block 1 lot 6.000 ------ --- ------ Cross Street CLARK ROAD ------------------------------ Date Of Last Pump Out' 0/00/00 ---------------------------------- Issue Date: 7/31/89 Judith T. Terry -------- Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK' ' Town of Southold r, l' .� 0�� Ql/ - Application No. Judith T. Terry, Town Clerk Town Hall, 53095 Main Road $10.00 Residential P: 0. Box 1179 $25.00 - Non-Residential Southold, New York 11971 O ® Telephone of `��> (516,) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE OWNER NAME: o l�Fa /V ©, y �, —� G?.o �- -a,P ry V;.k�,L/ OWNER MAILING ADDRESS: 2-1 d OWNER PROPERTY ADDRESS: Spew OWNER TELEPHONE NUMBER: TAX MAP NO. : Section Block Lot CROSS STREET: 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.) nature of Appli ant RECEIVED BY: Town Clerk's Office DATE: v d 4 i a g L 1