HomeMy WebLinkAboutCurcuru O$n ISI
iirC
SFJ
o �' �i Town Hall, 53095 Main Road
% P.O. Box 1179
, � .'.`�) Southold, New York 11971_ mss' �,,��
JUDITH T.TERRY a�� ,��`. 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. 1360-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CURCURU, PATRICIA
Mailing Address 1 4 WOOD HILL ROAD
Mailing Address 2
City St Zip WESTON CT 06883-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 203-227-0090
Tax Map No. section 66.00 block 2 lot 1 .000
Cross Street TOWN HARBOR LANE
Date Of Last Pump Out 0/00/00
Issue Date: 1/11/90 Judith T. Terr
Southold Town Clerk
(TOWN SEAL)
•OFFICE OF THE TOWN CLERK c�VFFO(,r�'•
Town of Southold O..iCQ Application No. /36
Lath- T. Terry, Town Clerk . ,
Town Hall, 53095 Main Road ~ I k
:G � $10.00 - Residential
-,�"�,t�a as +�
P. O. Box 1179 tri �;• � , $25.00 - Non Residential
\Y 7
Southold, New York 11971 Q 416,,lz r-ts1" *-60
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
- - - OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE (v I Ct C1 o
'OWNER NAME: } a i� C Cul-2,c, al
OWNER MAILING ADDRESS: WO n J r1 , 1_
tij 7,0 A/ u).-- ? 3
OWNER PROPERTY ADDRESS: -,A1GL., iqo , 4.7
L- r. I1 `_/
OWNER TELEPHONE NUMBER: ® 3 7 d 0 (/ try -71Z - 3'3g/
TAX MAP NO. : Section
Block ";-. Lot
�
CROSS STREET: ( � ftc+L:d'lo(yr 1Thck,`-,�
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.)
Si nature of Applicant
RECEIVED, BY: - - - - - - -- - - -
Town Clerk's Office
DATE:
4 -
7SPL-
.),/
0-
/
P j
ic,k Ls:s
cts
711 .jD