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Town Hall, 53095 Main Road
tr3 .' P.O. Box 1179
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JUDITH T.TERRY TELEPHONE
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rowN CLERK "�� (516) 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. 860-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CAIOLA, SALVATORE
Mailing Address 1 230 EAST 85 STREET
Mailing Address 2
City St Zip NEW YORK NY 10028-0000
Property Address 1 COUNTY ROUTE 48
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 212-772-8830
Tax Map No. section 51. 00 block 3 lot 9. 001
Cross Street CLARK ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/27/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 0FO��,4'-
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Town of Southold Q� , _ �o = Application No. 230
Judith T. Terry, Town Clerk ;tAi
Town Hall, Residential 53095 Main Road a �'=�
P. O. Box 1179 U2 ; Non-Residential
Southold, New York 11971 O ®, r,n. c _'•
TelephoneOi `� i
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(516) 765-1801
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for - -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 1D,`'�°/so
DATE Q1/5h
OWNER NAME: $, vo ti v . (,C GU/&
OWNER MAILING ADDRESS: 2.20 £a•S1 1 $ yeet
New /v-1 j /v/ #015-
OWNER PROPERTY ADDRESS: (01,(.kiti -RUt4-te,
So uli-ko-eccc) .y.
OWNER TELEPHONE NUMBER: (212) -172. -?Je3O
TAX MAP NO. : Section 5/ Block ,3 Lot 41. 1
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ,7 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.)
,5-ee- Vowr re card-s-1viovrit/A, C'essp uo-e Cov c",`
has 5u..b'c./7 cL /oca_tc-W) 72
Sig , ' re o Applicant
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RECEIVED BY:
Town Clerk's Office
DATE: