HomeMy WebLinkAboutCardona OFFICE OF THE TOWN CLERK °CIOUl'�CD
Town of Southold , Q� �, }� y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road . ��
P. O. Box 1179 ',� o r'�.t ` :•,
Southold, New York 11971 \ Q
Telephone -7°./ 44 e
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 471 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Charles A. Cardona, Jr.
OWNER MAILING ADDRESS: 11610 Main Bayview Road
Southold, New York 11971
OWNER PROPERTY ADDRESS: 11610 Main Bayview Road
Southold, New York
OWNER TELEPHONE NUMBER 516-765-1676
TAX MAP NO. : Section 88 Block 5 Lot 26
CROSS STREET: Corner lot - Rambler and Main Bayview Roads
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Exiting X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Judith T. T dry
Southold Town Clerk
DATE: October 22, 1987
(TOWN SEAL)
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- 'O`FFICE OF THE TOWN CLERK 'SOW '
Town of Southold �% ea -- , Application No. 2/71
Judith T. Terry, Town Clerk ` 0 .. ..#10,0„.„--,,,. ..,-,%,-,_
Town Hall, 53095 Main Road a Y . ' Residential
to .' i7 a
P. O. Box 1179 ')4 ' .„� �� .} Y Non-Residential
Southold, New York 11971 ,�. ". ' moi`
Telephone _5.�+te ��
(516) 765-1801
TOWN OF SOUTHOLD
l tEIVED
OCT 221987 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
InvOti C4ork Southold
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ l b , 00
DATE gisliq, fel
OWNER NAME: ( }-1,4 R L E__c 0 _ C piepo NA-✓ Tr.
OWNER MAILING ADDRESS: 1 I felt) MAIN 1- W16Nf QZ_
SO 1HoLi)j Ny I111(
OWNER PROPERTY ADDRESS: S A- F_
e ,
OWNER TELEPHONE NUMBER: 7 to ,S— l 6'7b
TAX MAP NO. : Section tt Block Lot r 6
CROSS STREET: HAIN 1314y V IFVV c' `041-dgi-a%/L.
TYPE OF SYSTEM: Septic Tank "' New Existing 2----
Cesspool
/Cesspool New Existing )
Residential 17 Non-Residential
DATE OF PREVIOUS PUMP-OUT: Li /I) 1.'•7
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.)
C4 rte" . -,� Api 1
Signature of Applic
RECEIVED BY:Cxc`—
r TDk's own Cler0 five
DATE: OCT 22 1997
Town Clerk Southold
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