HomeMy WebLinkAboutCitera 1 G�fOLK A
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JUDITH T. TERRY ' <: Town Hall, 53095 Main Road
TOWN CLERK ® T j P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
MARRIAGE OFFICER Fax Fax (516) 765-1823
�,y®1 ® 1� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2056-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner CITERA, ANTHONY & CAROLINE
Mailing Address 1 24545 MAIN ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 24545 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 109.00 block 1 lot 15.000
Cross Street ALVAH'S LANE
Date Of Last Pump Out 0/00/00
Issue Date: 2/22/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE'OF THE TOWN CLERK ' �FFUIL- =
Town of Southold � r. . ,ry ire, Application No.020�
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Judith T. Terry, Town Clerk . „, „
Town Hall, 53095 Main Road ''- $10.00 - Residential
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p. O. Box 1179 v' �yA ,.,,�' i ; $25.00 - Non-Residential
Southold, New York 11971 O `'� *.$
Telephone .Oj �� to
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
• for
OPERATION PERMITFIR p.
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SEPTIC TANK or CESSPOOL •,�F
FEB 1 71",
Operation Permit No.
Fee $
DATE
OWNER NAME: Anthony and Caroline A. Citera
OWNER MAILING ADDRESS: 24545 Main Road
Cutc'hogue, New York 11935
OWNER PROPERTY ADDRESS: 24545 Main Road (N/S Main Rd [Rte 25] 900° W/0
Alva'hs Lane) Cutchogue
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 109 Block 1 Lot 15
CROSS STREET: Alva'hs^`Lane -
TYPE OF SYSTEM: Septic Tank x New x Existing
Cesspool X New X Existing
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: newly constructed - never used
LOCATION MAP: Must be attached hereto before permit may be issued.
, p , (Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
4 7/0 •
RIV RSID, HOMES, INC.
:igriature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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