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HomeMy WebLinkAboutViola (2) ® 0 JUDITH T.TERRY � -4,:°) y 3 Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 01? tSouthold New York 11971 REGISTRAR OF VITAL STATISTICS ® �� Fax(516) 765-1823 MARRIAGE OFFICER ��o* W"or RECORDS MANAGEMENT OFFICER ®I 'O.006 Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER .ion OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3726-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner VIOLA, GEORGE J. Mailing Address 1 P. O. BOX 216 Mailing Address 2 City St Zip PECONIC NY 11958-0000 Property Address 1 995 HENRY LANE Property Address 2 City St Zip PECONIC NY 11958-0000 Owner Telephone No. 516-734-6467 Tax Map No. section 74.00 block 1 lot 14.000 Cross Street NORTH ROAD Issue Date: 11/24/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) • • o OFFICE OF THE TOWN CLERK cI\TRV( Town of Southold ks C'QG=\ Application No. Judith T. Terry, Town Clerk ;. y Town Hall, 53095 Main Road _ $10.00 - Residential P. O. Box 1179 cn = • ;' $25.00 - Non-Residential Southold, New York 11971 "*.$ Telephone Telephone 114 ' (516) 765-1801 : 1 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT • APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE It A3 / Q7 OWNER NAME: l.3"k ar'S x Vic. 1 OWNER MAILING ADDRESS: Hifnr7 ©, Box a1 c o,, . o L ) w.y, " /LW: OWNER PROPERTY ADDRESS: ek..► r�bav•t OWNER TELEPHONE NUMBER: ')'t 7"3� — .b 467 TAX MAP NO. : Section Block ) Lot i t" CROSS STREET: Ne c:61 a . \ S Ov1 44. 4- .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.) 00 / 41.r ;Sign re of Applicant S - GAS .c TaT,'0Y, RECEIVED BY: w tfie Town- Clerk's Office L L 7 RECPYED DATE: N 0 V 1 1997 • ,,�� ��?''� c�. < �r' c15JJ roc;