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HomeMy WebLinkAboutZori • tih id \VD 1I � 4®,� JUDITH T. TERRY %4 , `< Town Hall, 53095 Main Road TOWN CLERK F\ P.O. Box 1179 REGISTRAR OF VITAL STATISTICS 6n . � Southold, New York 11971 MARRIAGE OFFICER ( ) CG. sr° Fax 516 765-1823 1' ®� � Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1638-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner ZORI, ANTHONY AND MARY Mailing Address 1 20-11 21ST STREET Mailing Address 2 City St Zip ASTORIA NY 11105-0000 Property Address 1 4180 OAKLAWN AVENUE EXTENSION Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-5190 Tax Map No. section 70.00 block 9 lot 44.000 Cross Street CUSTER AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 3/11/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK VFO(,(-�'- } Town of Southold C'Q � Application No. Judith T. Terry, Town Clerk k ,} Town Hall, 53095 Main Road _ � $10.00 - Residential P. O. Box 1179 tri $25.00 - Non-Residential Southold, New York 11971 '® $4�` Telephone ' ( ‘NI) (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. iCo Fee $ t© DATE /1/ / i 'OWNER NAME: B; PONY M4-12,1 2,6 e( • OWNER MAILING ADDRESS: ,a,6 - 1/ ( S t�Go ( 2 , ,i«r OWNER PROPERTY ADDRESS: // ,'O © gC /itAL FVEYOUE - X E7U5/bn3 sO U r oL Ai +`�, 11'71 OWNER TELEPHONE NUMBER: 5R. - /ts-- 0 TAX MAP NO. : Section rip Block Lot 2J7 CROSS STREET: /i-U. 'JU‘ TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing X Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: U fie 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.) , Set_is Albaign tune of Appl•rca RECEIVED BY: AL) / Town Clerk's Office DATE: Y17/97 d-.4 f\(.EV 1I,.L.6.' QI 4— — .� .....2 y1.2. -OMR- ._ . . /6 0 __ -. roe* ........... .asn.- , Q 1' o c I , I e'- f � � x I' i I 1 U) o Z � . o. , .. 147,4;,1 I 1 0 O< > - AT -1- OA / ` ' 1 ,-t. 1 1 , 0 Cus-S5--pooL /--N1) G-2 -Tc -r-seil-14