HomeMy WebLinkAboutViola OFFICE Of THE TOWN CLERK ‘C31FUCki;'
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. G. Box 1179
Southold, New York 11971 ti p _ O�•'
Telephone jaid %No
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 188 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: John and Diane Viola
OWNER MAILING ADDRESS: 3505 Delmar Drive
Laurel, New York 11948
OWNER PROPERTY ADDRESS: 3505 Delmar Drive
Laurel, New Y6trk
OWNER TELEPHONE NUMBER: 516-298-9317 -
TAX MAP NO. : Section 125 Block 4 Lot c.‘,5
CROSS STREET: Gina
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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14411
Judith T. Terr •
Southold Town Clerk
DATE: December 233, 1986
(TOWfl SEAL),
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OFFICE OF THE TOWN CLERK �FFO
Town of Southold �� :-_ CQ _': Application No. e(r
Judith T. Terry, Town Clerk Y ,: fi ,
Town Hall, 53095 Main Road ~ :C Residential !�
p. O. Box 1179crl ` ' z - Non-Residential
Southold, New York 11971 O`j '�`�
70
Telephone _ .( �► • ,.•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /
Fee $
`95-
DATE a0,-01
9
OWNER NAME: �)r9h �L/ -� DM-Ardi d O A�j
OWNER MAILING ADDRESS: s-O De/ Ar
4),0 1 • // / / 7
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: ci 9\-3
TAX MAP NO. : Section /o25-... Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool � New Existing X
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
Signature of Applicant
RECEIVED BY: a 2 C._4-6 •
REcENEDTown SZlerk's a ffice
DATE: SEC 23 si
Town Clerk Southold