HomeMy WebLinkAboutVillano OFFICE OF THE TOWN CLERK '
Town of Southold Olj
Judith T. Terry, Town Clerk � " .
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971 ‘34:00 �` �-
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 194 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Elaine T. Villano
OWNER MAILING ADDRESS: Box 86A, RR 1
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 1950 Deep Hole Drive
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-9145
TAX MAP NO. : Section 123 Block 4 Lot 3
CROSS STREET: Richard Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Approx. 1984 or 1985
40tr ,P ri-017;Judith T. Terre_
Southold Town Clerk
DATE: January 6, 1987 �
II 1,
(TOWN SEAL)'
OFFICE OF THE TOWN CLERK �'FO , r
Town of Southold , �QS %. Application No./ y
Judith T. Terry, Town Clerk Z :`
. r ,: 7 Residential
Town Hall, 53095 Main Road � - ��:�<
P. O. Box 1179 .`' Non-Residential
Southold, New York 11971 .��`
Telephone ` .( y► '.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /94/
Fee $ /j) °c''
DATE /'j--1
OWNER NAME: , /Ce / .Q_/ / K /M ,'J o
OWNER MAILING ADDRESS: ,,,)( ?M
its
OWNER PROPERTY ADDRESS: /95O 0402, 164
Tet:i 14LIJ )-
OWNER TELEPHONE NUMBER: LJr76J2V-9f
TAX MAP NO. : Section ®j� 3 Block it Lot 3
CROSS STREET: / ICI t,1-II
TYPE OF SYSTEM: Septic Tank New Existing /
Cesspool New Existing ✓
Residential t✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: ti 02 a_67-0
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.)
7/1"'7L: 11"Signature of Applicant
RECEIVED
-�o`�L�� / „f
Town !lerk s Office
DATE: J141\1 6 1987
um., Nett Southold
Dsed co`nstrut'iion violate any zoning law, ordinance ui •,y-'-• - ( ) No
�o Will excess
fill be removed from premises: ( ) Yes 29�,,,914g
regraded ...................��..Yi,�;j,an0. ..$�►a I�mttitu¢1(Ione No. ...................:..
••..... Address • �`�`•" "
......... ...... Phone No. ......................
caner ofpremises ... Address .........
..........
................................... ....
Architect .................... .. Phone No. ..................
..........................
.. Address
Contractor ............................................................
•••• "" PLOT DIAGRAM
or proposed, and indicate all set-back from
roof
nd
"-‘.---1- ......-k,,r n Amcrrin+inn nrrnrrlinn fn rionr- nnr�
chna� cset_b ck dimensions indicate arty and distinctly all buildings, whether existing P ///"/"__
•..--- ,EZ - f
i I
I J
II $ .
• . it :, , 1 i
•
I 1111
J
I ,g
-, ,
Ib .! .,'. -7„' T.I �� I1 ,
`a '••;`;'•'•,-2:,3'.;
V K i4� l
�
r , \ \''\ _' r
ECl< V,
I i
4 ; is the applicant
•• Z” I
v
m ,
to make and file j
i ,46 Cq VIIIge and belief; and i
Ica I N/vim — /S17
D i
1 ' • tii-T
(:),, f, c I i ,
r r,F.
;; ';;'''
1 .A(eicl e :,,',,,',':,
IJ
..b LQ...'p ( r1V