HomeMy WebLinkAboutVindigni ,,001e)�1FQikc
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Town Hall, 53095 Main Road
$ P.O. Box 1179
_ l®1 44 �`ao�•�� Southold, New York 11971
JUDITH T.TERRY -�,-,l'�, TELEPHONE
TOWN CLERIC (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. 752-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner VINDIGNI, SALVATORE
Mailing Address 1 VINDIGNI, GERMAINE
Mailing Address 2 BOX 304
City St Zip EAST MARION NY 11939-0000
Property Address 1 1440 GILLETTE DRIVE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-2396
Tax Map No. section 38.00 block 2 lot 15. 000
Cross Street MIDLAND PLACE
Date Of Last Pump Out 0/00/00
Issue Date: 7/12/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK IrO = '_ �.
Town of Southold 0�� c CQ Application No.
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Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Residential ,/
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P. O. Box 1179 PI., > _ ��� Non-Residential
Southold, New York 11971 O ®_ `'' •`
Telephone o.( **/
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $JO
DATE 8 0
OWNER NAME: J Vc1J`rOre,Ovwd, 0 ir,Ov, v\C
VI:fldA19-1/
OWNER MAILING ADDRESS: 6y -50
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OWNER PROPERTY ADDRESS: l`l-f(? G-1 tleig Sr
C /iutri a-vt iL t193'/
OWNER TELEPHONE NUMBER: X17- 1V
TAX MAP NO. : Section 3 Block A Lot I5"
CROSS STREET: � el
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TYPE OF SYSTEM: Septic Tank New Existing , /
Cesspool 7 New Existing 1/
Residential 7 Non-Residential
DATE OF PREVIOUS PUMP-OUT: ((ct fri
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.)
Mr\AAAA,C 0 -
Signature of Applicant
RECEIVED BY: C%&-7Y-Oe-c-<--cep, 6JC�
R Town erk's Offi e
DATE:
Town Clerk Southold
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Job N° 86-1299
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