HomeMy WebLinkAboutAcquaviva *. �. Town Hall, 53095 Main Road
es® - ,1 P.O. Box 1179
; �"� �►� Southold, New York 11971
JUDITH T.TERRY 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. 1001-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner ACQUAVIVA, MICHAEL J.
Mailing Address 1 ACQUAVIVA, DEBRA B.
Mailing Address 2 76 JUNIPER STREET
City St Zip ISLIP NY 11751-0000
Property Address 1 NORTH SEA DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-581-3637
Tax Map No. section 54.00 block 5 lot 51 .000
Cross Street KENNYS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 2/06/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•• •..�'I
OFFICE OF THE TOWN CLERK /
Town of Southold �� CQ ' Application No. �
Judith T. Terry, Town Clerk f,,3`= �` .»
Town Hall, 53095 Main Road . '' "< Residential
P. O. Box 1179 u' Y ;' Non-Residential,
Southold, New York 11971 O �i
_ :Telephoned( ��)�'��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
rEa 156 OPERATION PERMIT
Town ,,,l,, SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ��
1 DATE 0 02-
OWNER NAME: 7/9/C_I-M-1-- /_ cv--- Yc2.__- 6f� zif v-j 1,/
OWNER MAILING ADDRESS: 714, I" et
/
717-O7
OWNER PROPERTY ADDRESS: 31,& J ,
OWNER TELEPHONE NUMBER: 56/ 3 3 7
TAX MAP NO. : Section Block 6 Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool, New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7
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 of pplicant
RECEIVED BY: 4. /._,6tc-__O
•Townjerk s OftAce
DATE: - .
TI -f:..c.44-:'
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APPLICAN-
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