HomeMy WebLinkAboutTerranova I
I�1 �SUFF04
• ®-
JUDITH T.TERRY �� � G'l'� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
ivy t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(516) 765-1823
MARRIAGE OFFICER �yijAGEMENT OFFICER '® I���
�Q� Telephone(516) 765-1800
FREEDOM OFRECORDS FIINFORMATION OF ICER ` �'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3643-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner TERRANOVA, GIACOMO AND
Mailing Address 1 GUVENC, BERNA
Mailing Address 2 1014 N. HAMILTON AVE.
City St Zip LINDENHURST NY 11757-0000
Property Address 1 4995 MILL LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-957-6252
Tax Map No. section 100.00 block 5 lot 2.000
Cross Street OREGON ROAD
Issue Date: 6/04/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OF, F10E OF THE TOWN CLERK scIFfJ .
Town of Southold �� , C4% Application
Judith T. Terry, Town Clerk Ej
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 cryi �`' $25.00 - Non-Residential
Southold, New York 11971
Telephone •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 6p- -8 -97
OWNER NAME: G ccm) 1 ap.A crt®m PDER. A G1A1IEN)C,
OWNER MAILING ADDRESS: I®I4 Kl, HA-WI-7010 Ei\ U
1.--Wb e i•1 N-0 1(4S ►I)/ W157
OWNER PROPERTY ADDRESS: 49,415 MILL LAI&
,A-11a-rumc y 11(459
OWNER TELEPHONE NUMBER: 1511P/41,1P/41, 6 17-609.5 oL
TAX MAP NO. : Section t (9D Block Lot a
CROSS STREET: OIZE 0 N\ flA
TYPE OF SYSTEM: Septic''Tank 'leo Aid New Q rr Existing
Cesspool S Existing
Residential \i/E,5 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.)
*I` 1-Ef E (2._WTh Colas GA geaka- A0 )4 6v3ep-rtIj
C M C 1-"ss Poo t_ CATE , As S tfio uJ ta 0A 0 i 6 c / s_ Q LA-ra _
nature of ppli
RECEIVED BY: Al)
Town Clerk''s 0 ice ° '
DATE:. 6/5/9
CA'4c
uN
1p UJB `
g
N)
M r LAG