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HomeMy WebLinkAboutVaccaro � r OG JUDITH T.TERRY �� _ y1 Town Hall, 53095 Main Road TOWN CLERK y Z P.O. Box 1179 rr7Southold,New York 11971 AEGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER `44, p��f Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER Q( ��010° Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER „ ossi OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3399-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner VACCARO, JOSEPH JOHN Mailing Address 1 2851 SOUTH OCEAN BLVD. 4A Mailing Address 2 City St Zip BOCA RATON FL 33432-0000 Property Address 1 1125 NORTH SEA DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 407-393-6420 Tax Map No. section 54.00 block 4 lot 13.000 Cross Street KENNY'S ROAD Issue Date: 10/23/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) r •• •I_ OFFICE OF THE TOWN CLERK COMA' 9Y Town of Southold , �� CQ� Application No.- / Judith T. Terry, Town Clerk . ;;,; • Town Hall, 53095 Main Road - �, $10.00 - Residential la P. O. Box 1179 i ��- $25.00 - Non-Residential Southold, New York 11971 4` 0���`� Telephoneo( * `� to (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /0 -- DATE /97/.5---4s- OWNER v/jam/4 r OWNER NAME: Io /7,j /of,/ ZJ ) c ,qi90 OWNER MAILING ADDRESS: ag6S©t� 71.1 �d'4--z i3Lo 2764, c,� yD av L 3 3 OWNER PROPERTY ADDRESS: /7 ;, Ate) f°T.S� g1,4 1),A7)7/F c'o /r/ OGD kV /19 71 OWNER TELEPHONE NUMBER: (27ui2 '7,) 3 �.3-6 9 0 TAX MAP NO. : Section Block Lot CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential 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.) -9Astri.,1 .nature of Applicant `i 1, 6¢ US RECEIVED BY: Town Clerk's Office DATE: • 1