HomeMy WebLinkAboutArslanian ct, 40:4t
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r=n Town Hall, 53095 Main Road
' � ` P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY i!` TELEPHONE
TOWN CLERK (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. 768-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner ARSLANIAN, VASKEN A.
Mailing Address 1 P. O. BOX 232
Mailing Address 2
City St Zip o MATTITUCK NY 11952-0000
Property Address 1 CAMP MINEOLA ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8489
Tax Map No. section 123 .00 block 6 lot 6.000
Cross Street KRAUSE ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 7/22/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
'•I
OFFICE OF THE TOWN CLERK �C� F�� �, �J
Town of Southold � f � C'® Application No. lam
Judith T. Terry, Town Clerk t`M°" 9,4'
Town Hall,
53095 Main Road , ~ €'` Residential
P. O. Box 1179 MI `0 1A6i
Non-Residential
Southold, New York 11971 44% -
Telephone el /Z6;','
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. I
Fee $ •
DATE
OWNER NAME: 4s hie / �g 2 gip.-j ,?
OWNER MAILING ADDRESS: 4 :).pq fro X .;2E`P
N y //9S 2
OWNER PROPERTY ADDRESS: (z, io
OWNER TELEPHONE NUMBER: , f f— eff f 3
TAX MAP NO. : Section Block - Lot
V 1
CROSS STREET: 4%4 VE Ro -P -
TYPE OF SYSTEM: Septic Tank- New ' % Existing
Cesspool /2".. New Existing /
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /1„/ L---6/ E 2_
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.)
Ado,"1.4 t EA'
Si natu e of Applicant
RECEIVED BY:
Tem-v4o erk's Office
DATE: JUL 22 'Me
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