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HomeMy WebLinkAboutAndreou „ ,,i JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERK • v P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER Fax�' .•, Fax (516) 765-1823 °y.0 $1a®i��” Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3129-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner ANDREOU, STANLEY Mailing Address 1 228 BATTERY AVENUE Mailing Address 2 City St Zip BROOKLYN NY 11209-0000 Property Address 1 5255 ROCKY POINT ROAD Property Address 2 City St Zip EAST MARION NY 11939-0000 Owner Telephone No. 516-477-0424 Tax Map No. section 21 .00 block 1 lot 8.000 Cross Street SOUTHERN BLVD. Date Of Last Pump Out 0/00/00 Issue Date: 9/27/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) a-.. of ., ••,..• OFFICE'OF THE TOWN CLERK SW MA' Town of Southold % � , , CQ Application No. ....3/ Judith T. Terry, Town Clerk % `., � � � 4_,C;!' �.�' .T:1: .•G%1 $10.00 - Residential Town Hall, 53095 Main Road t ,�; p. 0. Box 1179 cn ' ° i � $25.00 - Non-Residential Southold, New York 11971 O-45,/),,--; �0 ��` Telephone ' (516) 765-1801 TOWN OF SOUTHOLD ( SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL • Operation Permit No:---34: 5 , Fee $ //9. 4) DATE "11-76/ F 3 • OWNER NAME: siinz.-7-y- 1 1)1)1�f�, ,,(, T'� 1.)-e:., OWNER MAILING ADDRESS: 21- , ../�J ,�;•. 9 . X112°�rl g �.td' //a07 ‘eZ,_e:OWNER PROPERTY ADDRESS: -- 9 d `'j a,: . --,-----Avai ,5fisl--- /line/ i tv iY-1 /1 cir OWNER TELEPHONE NUMBER: 5S•_ 4/77- &y 7 a/ TAX MAP NO. : Sectio 7 Block / Lot .-4i— g a( I1" SQA 1 v r4 CROSS STREET: �(�R/ , TYPE OF SYSTEM: Septic Tank S New Existing -,)c Cesspool >( New Existing �� 1 Residential }P: Non-Residential DATE OF PREVIOUS PUMP-OUT: ,Z),147)il 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.) 421-4-' ) <4g6.-(Z-5 ignature-of Applicant RECEIVED BY: - Ade ... ', `own Cler ms's Ofice DATE: K&--R /2 _ . r- • , , _ _ _ _ , A___,„40-1-. _ . _ _ _ _ . . _ 9 n , . _ _ _ --- - -- --- --- ---- -- --- - - - - - -- - - - - - - - - - - - - _ _ _ . _ __ _ _ _ • _ __ _ _ _ 1 , 1 __ _ __ _ _ __ _ _ , _ _ _ _ _ . . , I 1 . _ _ . _ , _ _ _ _ . __ I _ , ._ 1 _ _ _ _ _1 _ _ , . . . _ . _ . _ . _ _ _ . __ . . _ , _ _ , _ _ _ _ _ ei r , r 9 7�j / W !! 4 Az r01 1 1.3 - - - - - - - N d CA) Po c-Ky pop07-- I-04D_ _ • ,