HomeMy WebLinkAboutAddonizio 'e. I����� .
Town Hall, 53095 Main Road
O P.O. Box 1179
r_ %� �� 1° Southold, New York 11971
JUDITH T.TERRY �� ,�,r"���� 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. 1012-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ADDONIZIO, FAUSTINO
Mailing Address 1 575 PINE TREE ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 575 PINE TREE ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6325
Tax Map No. section 104.00 block 1 lot 7.000
Cross Street SKUNK LANE
Date Of Last Pump Out 0/00/00
Issue Date: 2/09/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold � CQ - Application No. /a-2,
Judith T. Terry, Town Clerk . �w. +` 4'
Town Hall, 53095 Main Road - Residential
P. O. Box 1179 t -j•
Non-Residential
Southold, New York 11971 OO
Telephone : .( * •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT ,
APPLICATION
• -- - - -- - for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 9 r /
rr ,
OWNER NAME:` AV5 J /N 0 ®}2) 1741
OWNER MAILING ADDRESS: 7 J ,p 7-466
eu-rca 6-06
OWNER PROPERTY ADDRESS: 5 4dr
/
OWNER TELEPHONE NUMBER: 7 3 - (D 3 L�
TAX MAP NO. : Section /04
Block / Lot 7
CROSS STREET: 5,\K- U/QI(' Li 4
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential X 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 of Appl'
RECEIVED BY:
TownClerk's Office
• , DATE: 177r1
1,2/0 )