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HomeMy WebLinkAboutVazquez Town Hall, 53095 Main Road .‘• P.O. Box 1179 , , •!° Southold, New York 11971 - JUDITH T.TERRY `I-� 400' FAX(516)765-1823 '''�������/ TELEPHONE(516)765-1801 TOWN CLERK 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. 1273-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner VAZQUEZ, DONALD AND JEAN Mailing Address 1 46 ROUNDABOUT ROAD Mailing Address 2 City St Zip SMITHTOWN NY 11787-0000 Property Address 1 2165 BAY AVENUE Property Address 2 City St Zip EAST MARION NY 11939-0000 Owner Telephone No. 516-724-7859 Tax Map No. section 31 .00 block 17 lot 5.000 Cross Street RABBITT LANE Date Of Last Pump Out 0/00/87 Issue Date: 10/17/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK c�v�FO(,� e� Town of Southold O�� . �� '_ Application No. / Judith T. Terry, Town Clerk A-, Town Hall, 53095 Main Road � a � � - $10.00 - Residential P. O. Box 1179 � i $25.00 - Non-Residential Southold, New York 11971 O ® ` ` K Telephone ®( % (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. - Fee $ l/, OD DATE /0 027-0362 /YS7 OWNER NAME: 27A/ t c/ %A) 1447064 OWNER MAILING ADDRESS: 4t ROIJit/,�>43007. (5/tiiTNS o c- )� Neck /( 73'7 OWNER PROPERTY ADDRESS: 2/653.4y //SAI)G 64.5/ tk/4Ri7 &7'o ( ///q 3f ) OWNER TELEPHONE NUMBER: (57 721-7157 TAX MAP NO. : Section 03/ / Block /7 Lot ©.- L CROSS STREET: ,�� /T j ,706 TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing / Residential `� Non-Residential DATE OF PREVIOUS PUMP-OUT: WE,2 . i9i'7 (i4/PRax.) 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.) (.77 1/ / ' Signat'ufe of 91 can RECEIVED BY: • Town Clerk's Office DATE: 1 1 iimmi., I millim I I I I I 1 1 , =II 11=1.1= 111111M=ENIMIIN ' =UNE MEI 1. IIMMMIIIIII a MIIIIIIIIIIIIIIIIIIIIIIEM11111=111111111111111M1111•1111111111111 MIMI MIIIIIIIIIMMENIMMENI MENIIIIIIIIMOMMINIMMIMINIMENII IIIIIIIHIEIIIIIIIIIIIIINIIIIIIIIIIIIIII=MIEI I ass II , ' I i , 1 , i 5 E LMILIMMENEMiii.iii 55555•U •1 - IMME • EMEMEMEMEMEMEMEMEMMENE - - '-..iiniliiiiiliii • MOSE= . M --W iiMaini I 1 1 . 1111/1111.1 • • a •-t-. 111111111.- 1 t-il. 5555 1 . ...fi.‘I/ALIN -1.1 .../176,14-A) i __ , _, 11.1_ Liitl?, 126_ H . . . II- /!6.5"-- . -11 - 4 `- ' 0_6 III ‘1 • 11111 - ---' 1— i , , , ,1 .i. ME '- -, I 1 ' . ME - '''' MEN • j 1 ru . icl, 1 1 1I 1 , i • . i . , ioc' i I , i N 1 - I I I I Ii , . i , , , A ' 1 ----. - H-r-- ; - , , , , 7 : 1 . ! ! 1 - -Iii- 1 r- , , , , ' ,----',- - - --“- , , --. 1 __NOT-6 , ; //t/k-7X) /c200.0. _5 ! AR6 ,. dibAle€2-6'Ae'd.. ,4' ' , _________ . __:__________ , •1- I Li , ,. i , I , , , . 1 IIi I ' ll ; , r 1 I' 1 • 1 i , , . t 1 1 I' I , , , , , I I I I r