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HomeMy WebLinkAboutCartselos OFFICE OF THE TOWN CLERK • •c5IFO(kcl Town of Southold �� ; : , Oyu Judith T. Terry, Town Clerk Town Hall, 53095 Main Road P. 0. Box 1179 ��tn _ r i' =�n •• Southold, New York 11971 O ' r- •• , Telephone ; 1 4[ '' (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 285 Residential X Non-Residential Fee $ 10.00 Septic Cesspool x NAME OF OWNER: Charles Cartselos — OWNER MAILING ADDRESS: 1850 Bridge Lane Cutchogue, New YOrk 11935 OWNER PROPERTY ADDRESS: 1850 Bridge Lane Cutchogue. New York 11935 OWNER TELEPHONE NUMBER: 516-734-5879 TAX MAP NO. : Section 85 Block 2 Lot 28 CROSS STREET: Route 25 and County Rt. 48 _ TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing X Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: Unknown X9"54014664e. Judith T. Terry "1 Southold Town Clerk DATE: April 22, 1987 (TOWN SEAL) 1 ii fes, _ OFFICE OF THE TOWN CLERK �c$FD (,'.'- Town of Southold �% �tyCQG' Application No.��S- Judith T. Terry, Town Clerk Residential Town Hall, 53095 Main Roadd. '� :" P. 0. Box 1179 `, - >yi ;' Non-Residential Southold, New York' 11971 O ® ` 'i *-$ Telephone -./.0 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for ' OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. - Fee $ /a. try— . DATE flA,zc-hi 2 "?j /, e7 OWNER NAME: ci �,,,,,AC_[", (� -�� �C,:te03 OWNER MAILING ADDRESS: / 8g-0 /02/ .4. 1,4,v'G�- . C " go 6 0r.) /l/7. ) l 143 .S---- OWNER PROPERTY ADDRESS: c7aftic ,� �,LP:4 ' ' - OWNER TELEPHONE NUMBER: 6-14 ) 7 3 cf_ S.-8'V/ ' TAX MAP NO. : Section -S"------ Block a Lot 4„ _g CROSS STREET: ©$-e N 4- e Rt-i' ( TYPE OF"SYSTEM: Septic Tank New Existing , Cesspool . New Existing Residential �" Non-Residential DAT..... E OF PREVIOUS PUMP-OUT: --r ,. 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.) a2,_ e__ , -,et_ at.„,..(e )._ _ Signature of Applicant RECEIVED BY: p ----e....-1-4._. .------' ''.--(. Tow Cler s O fice DATE: -