HomeMy WebLinkAboutCervone etlw
y - Town Hall, 53095 Main Road
® J' P.O. Box 1179
• Southold, New York 11971
JUDITH T.TERRYFAX FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 941-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CERVONE, DAVID W. AND BARBARA
Mailing Address 1 485 GILLETTE DRIVE
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 485 GILLETTE DRIVE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-0045
Tax Map No. section 38.00 block 11. lot 1 .000
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/00
Issue Date: 12/05/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK CSFO _ (�
Town of Southold kCQ - Application No. d/
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Judith T. Terry, Town Clerk %� k �
Town Hall, 53095 Main Road o 4� w > Residential i,,-"'
P. O. Box 1179 u' '' :' h�i .' Non-Residential
Southold, New York 11971 4 ,
Telephone el-..el * NN '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ b 0
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DATE /2/VAA9/
OWNER NAME: 'aI'&6f2P AT 9 7,44,444- C: 0Ai t
OWNER MAILING ADDRESS: 'QS 6"1//6371P- Vit.
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OWNER PROPERTY ADDRESS: S> 9by.` a 4 -trf
OWNER TELEPHONE NUMBER: L/77—® 0 T•j
TAX MAP NO. : Section 1 Block 171AZIc✓ 119 rc✓1 Lot t4 2-
CROSS STREET: • P.„0,111§--- Es
TYPE OF SYSTEM: Septic Tank New Existing i "
Cesspool New Existing
•
Residential a7- 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.)
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✓ .LIZ/1-- —.
'Signatu're—of Applicant
RECEIVED :Y• �,,,_ -a e
''C-� Town Clerk's Offier¢ e
DATE: DEC 061988
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