HomeMy WebLinkAboutCostanzo ®tt � r�
t�+ Town Hall 53095 Main Road
v. O
��. P.O. Box 1179
=: 40� ��1i!� Southold, New York 11971
JUDITH T.TERRY %�10'I 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. 1427-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner COSTANZO, ROBERT AND BARBARA
Mailing Address 1 P. O. BOX 357
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 NEW SUFFOLK AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8419
Tax Map No. section 115.00 block 5 lot 18.000
Cross Street MEADOW LANE
Date Of Last Pump Out 0/00/00
----Atat.tett'
Issue Date: 3/21/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK COM
Town of Southold � • C�G� Application No. /4742-1
Judith T. Terry, Town Clerk . /41 ki.,,4; :�
Town Hall, 53095 Main Road ` 4' $10.00 - Residential
P. O. Box 1179 cn04t
l 'moi
$25.00 - Non-Residential
Southold, New York 11971 � 0��`�
Telephone 1
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
OperatiT n Permit No.
co
Fee $ iO•
DATE 51 vi lei 0
OWNER NAME:
OWNER MAILING ADDRESS: ? L3 , S7
141 , `19c-z
- OWNER PROPERTY ADDRESS: -irIT
�L-
OWNER TELEPHONE NUMBER: 'SI
TAX MAP NO. : Section i t 'j Block S Lot 18
CROSS STREET: t,i1C2,L4 14
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 o •
RECEIVED BY: - -
Town Clerk's Office
DATE:
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