HomeMy WebLinkAboutCassone 1
11�
tfuur
trn $ Town Hall, 53095 Main Road
.?� to
P.O. Box 1179
‘00® ��0.•'
Southold, New York 11971
JUDITH T.TERRY zi���� TELEPHONE
TOWN 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. 704-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner CASSONE, ANTHONY & DANIA
Mailing Address 1 3305 OREGON ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 3305 OREGON ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8457
Tax Map No. section 100. 00 block 2 lot 7 . 000
Cross Street ELIJAHS LANE
Date Of Last Pump Out 0/00/85
Issue Date: 5/17/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'cF-O(,r^ 7
Town of Southold -,.;e CQ ' Application No. / 6�
Judith T. Terry, Town Clerk _
° �. - I Residential
Town Hall, 53095 Main Road c � +
p. O. Box 1179 cn *x: - s � Non-Residential
Southold, New York 11971 .,44*`
Telephone ®.( c��� to
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE MAI
OWNER NAME: bN- , l4-0`v �/a ria' A eAg-s ok)P
OWNER MAILING ADDRESS: -3 :3 -05"--- COa66--0 e`) P--D
in 1A-71-11 -c-4--- ,&-ky _ , t9 S-2
OWNER PROPERTY ADDRESS: �A"14 (i.
OWNER TELEPHONE NUMBER: 57C " 9g- V 9S7
TAX MAP NO. : Section / OD Block c:). Lot 7
CROSS STREET: rj_e_rjA„,
&
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential j Non-Residential
DATE OF PREVIOUS PUMP-OUT: f 9?_ -
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.)
Signa e of Applicant
RECEIVED BY: ate___
;lei ,�t.wn erk's Office
DATE: MAY 17 6''
f£
W
EJ
_ o
7I \\./
C
I
gA2nl
1