HomeMy WebLinkAboutBusso ,ecOf Mire
Town Hall, 53095 Main Road
s' P.O. Box 1179
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Southold, New York 11971
JUDITH T.TERRY r /��, FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 965-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BUSSO, JOSEPH
Mailing Address 1 P. O. BOX 102
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 GILLETTE DRIVE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-2012
Tax Map No. section 38.00 block 2 lot 16.000
Cross Street MIDDLAND ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 12/20/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cOFU(,(- =
Town of Southold , 0�� 3T }hCQG = Application No. 94'-‹
Judith T. Terry, Town Clerk . r;"' r: y
Town Hall, 53095 Main RoadResidential
P: O. Box 1179 cn 'T ' i �� Non-Residential
Southold, New York 11971 4 7
Telephone "40,1 , �,0to,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK dr CESSPOOL
Operation Permit No.
Fee $ 10..00 •
DATE IZ- I;S- gg
OWNER NAME: 0SEpkLQ-Sso
OWNER MAILING ADDRESS: ?.O. EOX 10�,
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OWNER PROPERTY ADDRESS: a;
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OWNER TELEPHONE NUMBER: S I -- `?-7 _ p
TAX MAP NO. : Section 34 Block .. Lot ) ,
CROSS STREET: \k\c&dLALskDg-c\
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing
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.)
ta-
•
Signature of Applicant
/
RECEIVED ;BY:
Town Clerk's Office
•
DATE: •
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