HomeMy WebLinkAboutCaraftis OFFICE OF THE TOWNCLERK 'c3 SLC'
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971 Js- •'
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 156 Residential X
Fee $ 10.00
Non-Residential
Septic ' Cesspool X
NAME OF OWNER: Charles Carafti,s
OWNER MAILING ADDRESS: P.O. Box 1404
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Naugles Drive
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-5936
TAX MAP NO. :' Section 99 Block 4 Lot 23
CROSS STREET: Luther Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New , Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Judith T. Terry a
Southold Town Clerk
DATE: November 20, 1986
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(TOWN ,SEAL)
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OFFICE OF THE TOWN CLERKI- , . ; , �F •FO
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Town of Southold NQS . CQ Application No./5--
Judith T. Terry, Town Clerk �►:
Town Hall, 53095 Main Road � ., :G Residential
P. 0. Box 1179 vi '` 3, z. Non-Residential
Southold, New York 11971 O �� '
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Telephone *j � Y►�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. fS
Fee $ /0 °�
/l
DATE �� X
OWNER NAME:
OWNER MAILING ADDRESS: 03$ Pa-014 F'& 0
/-64 -' - -
OWNER PROPERTY ADDRESS: 40,
OWNER TELEPHONE NUMBER: 4F--try a--6
TAX MAP NO. : Section q 9, Block 1 Lot ,3
CROSS STREET:
TYPE OF SYSTEM: Septic Tank 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.)
rila./64 ',-
Signature of A.plicant
RECEIVED BY: GCrzc�d
Town(ftlerk's Office
RECEIVED
DATE:
Town Clerk Southold
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