HomeMy WebLinkAboutCatullo OFFICE OF THE TOWN CLERKc��if-kJ(
Town of Southold ,_
Judith T. Terry Town Clerk � yo :4 °= ? j
Town Hall, 53095 Main Road ;
P. 0. Box 1179 v' r fiY% `�
Southold, New York 11971
Telephone -AOI
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
• SEPTIC TANK or CESSPOOL
Operation Permit No. 83 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
NAME OF OWNER: Dante H. Catiilln
OWNER MAILING ADDRESS: Summer: P.O.R. R95 Winter: 3114 S. Ocean Blvd.
Mattituck, NY 11952 Highland Beach, FL
33431
OWNER PROPERTY ADDRESS: Bailie Beach Road
Mattituck, New York
OWNER TELEPHONE NUMBER: Summer: 298-4580 Winter: 305-272-9609
TAX MAP NO. : Section 99 Block 3 Lot 9,3
CROSS STREET: East Side Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing xx
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: August 1986
•
Judith T. Terry
Southold Town Clerk
DATE: October 7, 1986
(TOW N SEAL)
OFFICE OF THE TOWN CLERK c�� ',Fdt'�� '=
Town of Southold �Q : Application No. 3
Judith T. Terry, Town Clerk y ''
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Town Hall, 53095 Main Road o µ{ xr �� < Residential__
P. O. Box 1179 c' � Y :' Non-Residential
Southold, New York 11971 � ® ,- !/o���`
Telephone = d 's
(516) 765-1801
0,1TOWN OF SOUTHOLD
85
bnol"ut 4'1 �� SOUTHOLD WASTEWATER DISPOSAL DISTRICT
croon CIsq\c Sofilokd
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ?.
Fee $ M
DATE
OWNER NAME: T ll C-/ i 7 L---L7 c
D, 13- $ 5 3 A I L.I r $E 1'1 a-✓c-IT/
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: C
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OWNER TELEPHONE NUMBER: -�p S= G�� - a�� 07
TAX MAP NO. : Section 99 Block (3 Lot 93
CROSS STREET: 19_57- cS/bL
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.)
Signature of Applicant
RECEIVED BYe
Town Clerk's O ice
DATE: _ SCA
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