HomeMy WebLinkAboutTrikoukas OFFICE OF THE TOWN CLERK c FG(.
Town of Southold %`", ���
Judith T. Terry, Town Clerk 4 Ot, V t
Town Hall, 53095 Main Road r s s -
P. O. Box 1179
Southold, New York 11971r- ,
Telephone ss Q(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 538 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: JOhn Trikoukas
OWNER MAILING ADDRESS: P.O. Box 149
East Marion, New YOrk 11939
OWNER PROPERTY ADDRESS: 1500 Aquaview Avenue
East Marion, New York
OWNER TELEPHONE NUMBER: 516-477-2058
TAX MAP NO. : Section 22 Block 2 Lot 34
CROSS STREET: Cedar Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: None .
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Southold Town Clerk
DATE: December 14, 1987
(TOWN SEAL) •
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OFFICE OF THE TOWN CLERK Ic3IFO(x = -
Town of Southold �� CQ ' Application No. J34'
Judith T. Terry, Town Clerk . r, �►
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Town Hall, 53095 Main Road Residential
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P. -0. Box 1179 cnWA . : i `' 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.c5 c.3/
Fee $ �d
DATE
OWNER NAME: 'IDf�'� 0 JP .g
OWNER MAILING ADDRESS: WOO /14?ti vie Ap6, ?0 , B04 /v�
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: y 76 - 77 �
TAX MAP NO. : Section a p- Block Lot ,N
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.)
Signat e o Applicant
RECEIVED BY: ca- `C
me�� ;t own lerk's 0 fice
DATE: DEC 14 1537
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