HomeMy WebLinkAboutTarabocchia OFFICE OF THE TOWN CLERK ' •s�`j�Fo(�
Town of Southold ®�® ,,,� 4 .
Judith T. Terry, Town Clerk �� ,t,�'O '
Town Hall, 53095 Main Road 8 , . i" >
P. O. Box 1179 ��� �� w r
Southold, New York 11971 t
Telephone eeit 41
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 33 Residential XX
Fee $ !0.00 Non-Residential
• Septic Cesspool xx
NAME OF OWNER: John Tarabocchta
OWNER MAILING ADDRESS: 655 Hummel Avenue
Southold, New York 11971
OWNER PROPERTY ADDRESS: 655 Hummel Avenue
Southold, New York
OWNER TELEPHONE NUMBER: 765-3205
TAX MAP NO. : Section 63 • Block 2 Lot 20
CROSS STREET: Youngs Avenue
TYPE, OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown (7/1/86)
I Judith T. Ter
Southold Town Clerk
DATE August 29, 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERKI�
Town of Southold %c51 FO`n 4, , Application No. Jam
Judith T. Terry, Town Clerk � ::.
Town Hall, 53095 Main Road ,
a , 4 t Residential
4
P. O. Box 1179 cn i `, °,_ '► ; Non-Residential
Southold, New York 11971 O *•�`�
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Telephone -4Q�.* ,�i0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. `5 ''
Fee $ M
DATE ,is - g - 1 6
OWNER NAME: g
e toy %A- (2 � 130 (6 6 H/ ill
OWNER MAILING ADDRESS: 6S dc H O SIN& I. 4 VI
( f_ro v710 L p NY aft/
(7 OWNER PROPERTY ADDRESS: 0 /714/ Qi. M,Rt.A r4 R4 ® tee/-(//�
OWNER TELEPHONE NUMBER: Y6S— L d S
i
z TAX MAP NO. : Section 4 3 Block Lot Q
CROSS STREET: Xy0 ti,h�l -S AAry f.L�
V
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 1,, / New Existing
Residential (/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: --7/i ,-
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.)
a44 (0,A4ZeCerlit-,OL
Signature of Applicant
RECEIVED BY: _ �
Town CI k's Office
DATE: a(�, /S,
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