HomeMy WebLinkAboutCisterino OFFICE OF THE TOWN CLERK 'oS�FFWire'
Town of Southold G
Judith T. Terry, Town Clerk •Z „rf-t
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971 O �
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Telephone -714
(516) 765-1801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 317 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Camillo and Anna Cisterino
OWNER MAILING ADDRESS: 324 Champlin Place
Greenport, New York 11944
OWNER PROPERTY ADDRESS: 324 Champlin Place
Greenport, New YorkLL
OWNER TELEPHONE NUMBER: 516-477-1108
TAX MAP NO. : Section 34 Block 3 Lot 23
CROSS STREET: Route 25
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X - - Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1986±
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Judith T. Ter -
Southold Town Clerk
DATE: July 13, 1987
• (7OWN.,SEAL)
OFFICE OF THE TOWN CLERK 1ORI/ r -
Town of Southold ���. lQ ' , Application No
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road o `° :G Residential
P. O. Box 1179 � z Non-Residential
Southold, New York 11971 ® ® ;`aO�P��
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Telephone ( }i'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
•
Fee $ /6
DATE 6 j /-4e
OWNER NAME: , ( f(U - a iNte
OWNER MAILING ADDRESS: 2-'{
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OWNER PROPERTY ADDRESS: 3,,.�4 A e_
OWNER TELEPHONE NUMBER: ie ciZZ C d O ,�
TAX MAP NO. : Section (j: Y. 6 p Block 0 ,; Q 0 Lot 3. p® O
CROSS STREET: 'KT a
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool )c, New Existing '
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: n— / ( ,
LOCATION MAP: Must be attached hereto beforc, •
e`permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
(241,4,2.4.e-
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Signature of Applicant
RECEIVED BY: 0/
own t(erk's Off f e
DATE:
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