HomeMy WebLinkAboutCalderone 0,010
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Town Hall, 53095 Main Road
- P.O. Box 1179
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or Southold, New York 11971
JUDITH T.TERRY P*.• TELEPHONE
TOWN CLERK WW (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. 873-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner CALDERONE, ANDREW AND MARY
Mailing Address 1 23 WEST 12TH STREET
Mailing Address 2
City St Zip HUNTINGTON STATION NY 11746-0000
Property Address 1 PARK VIEW LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-423-4515
Tax Map No. section 15. 00 block 5 lot 24. 027
Cross Street PLUM ISLAND LANE
Date Of Last Pump Out 0/00/00
Issue Date: 10/04/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cOFO(K '• C
Town of Southold C Application No. 0 1,.-:))
Judith T. Terry, Town Clerk
Town Hall 53095 Main Road -'� Residential
P. O. Box 1179 cn `� ` `'
.� ��� '�i � Non-Residential
Southold, New York 11971 O ® Y` �.:47
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Telephone '�.(
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - - ,- for - -- - - - -- -- - -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL —�
Operation Permit No.
Fee $ • -
DATE / / / ?�
/�
OWNER NAME: '40D- 2E 0 7 M'N-lay 0ALLbe200
OWNER MAILING ADDRESS: 23 Lk). 1,-2 s—
A-vtsTrJCn - NI 1174(o
OWNER PROPERTY ADDRESS: PP2k VIS' LI�NF
O Q LGN I 0 •)(,
OWNER TELEPHONE NUMBER: 1-12.3 - L\515
TAX MAP, NO. : Section. Block 5 Lot 2 Ljs 27
CROSS STREET: 0_-(Ail IS 70 LPr
TYPE OF SYSTEM: Septic Tank l/ New Existing
Cesspool ✓ 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.)
-44YeL-eficeGaVel'IA°e.‘')x'
Signature of Applicant
RECEIVED BY:
RECEiveown Clerk's Office
DATE: 1B
'Town Oak Southold
•
50
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