HomeMy WebLinkAboutTuminello _ Town Hall, 53095 Main Road
V51) 0' ' P.O. Box 1179
`i►� Southold, New York 11971
JUDITH T.TERRYpolo
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. 1106-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TUMINELLO, LARRY J.
Mailing Address 1 955 SHIPS DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 955 SHIPS DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5338
Tax Map No. section 79.00 block 3 lot 34.000
Cross Street NORTH BAYV I EW ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 5/11/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
"7
OFFICE OF THE TOWN CLERK CO�Fo -
Town of Southold CQG' , Application No. /lab
Judith T. Terry, Town Clerk . "
Town Hall, 53095 Main Road 4. Residential
P. O. Box 1179 u' �`g . t ' ' ' Non-Residential
Southold, New York 11971 P%•tt;
Off- ••
Telephone : ( '��,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
•
SEPTIC TANK or CESSPOOL
Operation PermitmigNo.
Fee $ L 0. v (y
DATE / ® •
OWNER NAME: 4ekkey.
� �(� islita- -49
�31 S/
OWNER MAILING ADDRESS: I'S �/p-�VZ
CoGtho(e j Airy f!R' 7 f
OWNER PROPERTY ADDRESS: /
S mo vg-
OWNER TELEPHONE NUMBER: -3-13—aa3171
TAX MAP NO. : Section Block Lot / I--
CROSS
l'CROSS STREET: /VD/,W-- AifyiI(0� ) J
TYPE OF SYSTEM: Septic Tank / New Existing
Cesspool New Existing t/
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: P kZ- ( TV10
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.)
Alf 4
Signar r o AUplicant
RECEIVED BY:
Town Clerk's Office
DATE:
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