HomeMy WebLinkAboutAlioto OFFICE OF THE TOWN CLERK VUrl,
Town of Southold �Q �G
Judith T. Terry, Town Clerk ' 4.13;. M
Town Hall, 53095 Main Road o -®
P. O. Box 1179 A tr3
Southold, New York 11971
Telephone ( .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 510 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X_
NAME OF OWNER: Concetta Alioto
OWNER MAILING ADDRESS: 1495 Oak Drive
Southatd, New York 11971
OWNER PROPERTY ADDRESS: 1495 Oak Drive
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-5637
TAX MAP NO. : Section 80 Block 1 Lot 43
CROSS STREET: West Shore Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
•
DATE OF PREVIOUS PUMP-OUT: Approx. 1981
•
Judith T. Te
Southold Town Clerk
DATE: December'2, 1987
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ss\FFU(,l(
Town of Southold ; Application No. 67/6
&iAral-411,4,1,
Judith T. Terry, Town Clerk ; 1 Residential
Town Hall, 53095 Main Road c :x-.� .-
P. O. Box 1179 v' g ,� `R . Non-Residential
Southold, New York 11971 A=y f= ,�`
Telephone *or
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ S-/6
DATE / / 7
OWNER NAME: e./0/1/ d' 1f' 13-1-4 r-z
OWNER MAILING ADDRESS: / y 175-
D /<
,50 I), thy - /i 7 /
OWNER PROPERTY ADDRESS: / V. (7 .61-- A-A1
_5 0 v1-171-04_1) p 0,y-. / ( t7 7 /
OWNER TELEPHONE NUMBER: 17 (b ,j - 5 as 3 7
TAX MAP NO. : Section (? -/ 1/13 Block Lot
CROSS STREET: L�1 $ /f® p j .
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential r/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: 14-0 6 I x S
LOCATION M P: 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 Applicant
RECEIVED BY:
Town Clerk's Office
RECEIVED
DATE:
DEC
iomp ClariK SOUth0ld