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JUDITH T. TERRY � ,M .:-,,�y., . Town Hall, 53095 Main Road
TOWN CLERK ti',,c„ - P.O. Box.1179
' Southold, New York 11971
REGISTRAR OF VITAL STATISTICSb 6 ars'>>`� _f' ; ,��
M ' Fax (516) 765-1823
ARRIAGE OFFICER
®��® ,s�, ��!' Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1811-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ZITO, FRANK
Mailing Address 1 RR1, BOX 60, WEST CREEK AVENUE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 985 TRACK AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5511
Tax Map No. section 137.00 block 1 lot 25.000
Cross Street STILLWATER AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 11/21/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �OFO
Town of Southold - �� Application No. /V
Judith T. Terry, Town Clerk . � '.
Town Hall, 53095 Main Road ~ = '� ) $10.00 - Residential t...."/P. O. Box 1179 � L ,'` • $25.00 - Non-Residential
Southold, New York 11971 O `
Telephone e •j 0 -
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ J(7 '
DATE 9) .Q9 lq)
OWNER NAME: r:".ro C\C 2 ►+t
OWNER MAILING ADDRESS: I b'I- (o . & r o_tr. ',e /'T-u-e
o 1\ 11937-
OWNER
1937-
OWNER PROPERTY ADDRESS: -9 - V'& QFC
OWNER TELEPHONE NUMBER: 13 i(
TAX MAP NO. : Section / Block I Lot a
CROSS STREET: +t \,\ Lxd-fX
TYPE OF SYSTEM: -Septic Tank __ New Existing I
"" Cesspool New Existing V
Residential l� 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.)
:41-11—Sign re ,'.Applicant
RECEIVED ,BY:
Town Clerk's Office
RECEIVED
DATE: .
NOV2-' 1991
Town Clerk Soutfioli'
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