HomeMy WebLinkAboutAgeci OFFICE OF THE TOWN CLERK • •C��FRA'rt
Town of Southold ,, Do y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179 0
Southold, New York 11971 Q y •'
Telephone Q./ ire
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
•
SEPTIC TANK or CESSPOOL
Operation Permit No. 255 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Vito and Anita Ageci
OWNER MAILING ADDRESS: 155 Rose Lane
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 335 Oak Street
Mattituck, New YOrk
OWNER TELEPHONE NUMBER: 516-298-9424
TAX MAP NO. : Section 141 Block 1 Lot - 22
CROSS STREET: Youngs Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: FEbruary 17, 1987
•
Judith T. Terry
Southold Town Clerk
DATE: April 7, 1987
'(TOWN SEAL)
/
OFFICE OF THE TOWN CLERK c�VFFU/ •
Town of Southold �� f _-. /;) Application No.eRs
Judith T. Terry, Town Clerk .�
Town Hall, 53095 Main Road '� Residential
o
P. O. Box 1179 cn ' ;' Non-Residential
Southold, New York 11971
Telephone
"&t.
,( JUI � •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
• OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 7/cr7
OWNER NAME: VI To h oTi3 PC://f C;
OWNER MAILING ADDRESS: /SS kas e
A).
OWNER PROPERTY ADDRESS: 335 Oak ,cr
rei 7C�7 �! C !l "'Z-
OWNER TELEPHONE NUMBER: sr/ 0L9 1 — rj ci
TAX MAP NO. : Section — / 9/ Block / Lot .2a2
CROSS STREET: yiou n 5 S )qt) °e
TYPE OF SYSTEM: Septic Tank ,New Existing
Cesspool Existing
Residential `, Non-Residential
DATE OF PREVIOUS PUMP-OUT: .21/17/S7
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.)
_ , (V•,Signature of •gl.Iicant
RECEIVED BY:
Town Clerk's Office
DATE:
C`