HomeMy WebLinkAboutZuzulo din
Town Hall, 53095 Main Road
P.O. Box 1179
=_�® � iSouthold, New York 11971
JUDITH T.TERRY �� FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-
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. 1062-R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
New Existing X
Name Of Owner ZUZULO, MARTIN AND CECILIA
Mailing Address 1 789 PELHAMDALE AVENUE
Mailing Address 2
City St Zip PELHAM NY 10803-0000
Property Address 1 2335 SIGSBEE ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 914-738-2656
Tax Map No. section 144.00 block 2 lot 23.000
Cross Street PECONIC BAY BOULEVARD
Date Of Last Pump Out 0/00/00
Issue Date: 3/29/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
1 -
SI I
OFFICE OF THE TOWN CLERK' S�FHU,�
Town of Southold _ - �� CQG•.;t` Application No. /6
Judith T. Terry, Town Clerk 1;41 ;,/
Town Hall, 53095 Main Road Residential
v' Non-Residential
P. O. Box 117 9 �
Southold, New York 11971 O � ;.�o ��`
Telephone 1 ',
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for - •
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /67
Fee $ /0 -
DATE 3 1 0-9
OWNER NAME: /)1 p)--p_'{G rl d—' CG-6Lt f (> 0),0
OWNER MAILING ADDRESS: 7 d f —/-1 -#'•Wl1 Ave-•
PE4z,v-0--ow-) tr r0 3
OWNER PROPERTY ADDRESS: 3 S S ? &-s
(14 123-7" T i T L 4 .y. (L°-
OWNER TELEPHONE NUMBER: �,i'-() 7 3 - 2 S-G
a 1r®0
TAX MAP NO. : Section J 9 J Block 2 tot
CROSS STREET: rib_zp y c`c- I' I V •
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential ` Non-Residential
DATE OF PREVIOUS PUMP-OUT: pLt_ ;/
LOCATION MAP: Must be attached hereto before permit, may be issued. ", CU-e*.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest roach)
keLt-A-Azi_
Signature of Appl cant
RECEIVED BY: X---cQ
wn Ceerk's Office
DATE:____________n :..
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