HomeMy WebLinkAboutCavaliere r��®eV mutfb,
'v' 6 Town Hall, 53095 Main Road
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� P.O. Box 1179
� sem, ��I�! Southold, New York 11971
JUDITH T.TERRY ® `� �''�� FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 1350-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CAVALIERE, LOUIS & ANGELINA
Mailing Address 1 3570 DELMAR DRIVE
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 3570 DELMAR DRIVE
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-5003
Tax Map No. section 125.00 block 4 lot 18.000
Cross Street PECONIC BAY BOULEVARD
Date Of Last Pump Out 0/00/00
Issue Date: 12/20/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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QFFICE OF THE TOWN CLERK c3\ \T _
.Town of Southold OQ C - Application No. /(3, 'D
Judith T. Terry, Town -Clerk .zag ��,„, 5�- y
�,, .0 1 $10.00 - Residentia"
Town Hall, 53095 Main Road
P. O. Box 1179 - '� i �. „r ,�� �� $25.00 - Non-Residential
Southold, New York 11971 O'�7® 1.1.:
Telephone *411N 14'.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
0 SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE ILA 'R /
OWNER NAME: L cD s �- F-,,� � 11 ,E ba 0_,41,14:a.1\ •
OWNER MAILING ADDRESS: 3 ?-o QeA ,r \--V\v
L.,/),k)c \ , 'cy 11 (1)-i2
OWNER PROPERTY. ADDRESS
OWNER TELEPHONE NUMBER: (c I b) 2 — c Oo 3
TAX MAP NO. : Section ,ZS Block Lot ) g
CROSS STREET: P-e_0-0,A . ' y -
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.)
• ifieL,462_,
Signature 'of Applicant
RECEIVED, BY; c(, -
RECEIslywDOC lerk s Office
NT
DATE:. DEC r
Town Cleric Southold'
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