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HomeMy WebLinkAboutTroccoli 10 • Town Hall, 53095 Main Road ' gb` /�' P.O. Box 1179 f2 $T:',�� Southold, New York 11971 JUDITH T.TERRY '�41..�„04,1101 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. 1237-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner TROCCOLI, ROBERT Mailing Address 1 BOX 559 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 710 JOCKEY CREEK DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-3095 Tax Map No. section 70.00 block 5 lot 12.000 Cross Street ROUTE 25 Date Of Last Pump Out 0/00/00 Issue Date: 8/29/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) r. Y • j • OFFICE OF THE TOWN CLERK •j a F Town of Southold �' O�� �( CD ; Application Nof4': Judith T. Terry, Town Clerk Town Hall, 53095 Main Road a .:_. -< $10.00 - Residential !/ P. O. Box 1179 cn 'fix ���'�`� � �.•. . �-��� � $25.00 - Non-Residential Southold, New York 11971 O rte Telephone 1Q( 1E4 �� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT • APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE 1/14:59/ OWNER NAME: (415614— OWNER MAILING ADDRESS: a K S© U 71-6 c- OWNER PROPERTY ADDRESS: / 0 CIt6C-41--re-14t brc S-D 1f1140 LIS / ! 5 -) ( OWNER TELEPHONE NUMBER: L 3 0 ; TAX MAP NO. : Section ® Block Lot 1 ,� CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential 1. / 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.) /: Havg£ ----( I Signature of Applicant RECEIVED BY: Town Clerk's Office MEW DATE: AUG 2 ��� I ; . ; I , I 1 ! 1 1 I I ! 1 di 1 I ! I , I I I f I . 1 1 i 1 "=',------ .....!! , ! I I ! Er— i 1 I ! I I 1 ! . I 1 11 1 1, 1 , 1 ' 1 b f,--aK i , , i 1 , , ! , " . 1 e ___ ,...._ ...„.,..__J.L., ; 1 ____I , , iii. [ 1.110; 1 1 1 1 1 1 , , . 1 1 , , , , , 1 - 1 1 ! I kJ° -v- s---et.„.7-, _ lit 1 . 1 , 11 1 1, I .1 Ii .... : , I 1 1 1 . , ! , 1 , I 1 I I I I I i I 1 ' I _I____. /\,,,/ , • ,i . i , ! I 1 , " ! I i , . f•—•77,-;904-tris„e4,1 1I I , I I I , ' — , . ' ! , I 1 $ ! 1 I 1 I ! I 1 I 1 i i _.1. ' --i 1 1 1_____I , , , 1 1 I 1 , I , i , , I I i 1 I r I I 'I, I I 1 1 1 I I HI i I ! I I , I ' I , ---1---7 1,---1 , I ! ; I I I I I I