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HomeMy WebLinkAboutTortora 110 Town Hall, 53095 Main Road ttP P.O. Box 1179 '74--t—'576(12 _ y® ��® �� Southold, New York 11971 JUDITH T.TERRY —. i!!, TELEPHONE TOWN CLERK (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. 889-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner TORTORA, SALVATORE AND LYDIA Mailing Address 1 106 LUTHERS ROAD Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 106 LUTHERS ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-9408 Tax Map No. section 106.00 block 3 lot 5.000 Cross Street EAST ROAD Date Of Last Pump Out 0/00/00 Issue Date: 10/18/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) " „e OFFICE OF THE TOWN CLERK ��FFe(i.�'= Town of Southold - CQ ' • Application No.L� Judith T. Terry, Town Clerk ` r3 Town Hall, 53095 Main Road 8 P: Residential P. O. Box 1179 cn V.W3r: z Non-Residential Southold, New York 11971 O10141%`�j 0��.` Telephone : '° (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION • for - OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /7) DATE /?)' OWNER NAME: ‘c4(/ I31l‘€i C dci CTO �� = OWNER MAILING ADDRESS: JUS 6 (A)TOP-J; Z0 OWNER PROPERTY ADDRESS: 5i114/1/ OWNER TELEPHONE NUMBER: 2qg qq o key- TAX MAP NO. : Section O Block 99 Lot O CROSS STREET: FA-S/7" TYPE OF SYSTEM: Septic Tank New Existing Cesspool l/ / New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: - ;s LOCATION MAP: Must be attached hereto before pe it may be issued., (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) Signature of Applicant RECEIVED BY: SECy,.wn C 'sO ilerkce `A.` DATE: tkii 131989 Town Clerk Scaffold r` 2 k. [5 r - _ o - f 1i • tt� . I' I fj - r c.' C... uS:S'.-9oL$