HomeMy WebLinkAboutBarsali fl
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T ; Town Hall, 53095 Main Road
c' W$ P.O. Box 1179
=�® ® ��®�,�'� Southold, New York 11971
JUDITH T.TERRY =, 1 � i TELEPHONE
TOWN CLERK ..,,,#off (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. 764-R Residential X Non-Residential
Fee $ 10. 00 Septic X Cesspool
New Existing X
Name Of Owner BARSALI, ALDO
Mailing Address 1 P. O. BOX 130
Mailing Address 2
City St Zip CUTHCOGUE NY 11935-0000
Property Address 1 2270 HIGHLAND ROAD
Property Address 2
City St Zip CUTHCOGUE NY 11935-0000
Owner Telephone No. 516-734-7444
Tax Map No. section 102. 00 block 8 lot 27. 000
Cross Street SPUR ROAD / CROWN LAND LANE
Date Of Last Pump Out 0/00/00
Issue Date: 7/19/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ;`. tSOFO(A' ' ` 1
Town of Southold , � 5' C4%-, Application No. 76 7
Judith T. Terry, Town Clerk ,, ;ty
Town Hall, 53095 Main Road -� 1 Residential
P. O. Box 1179 :ettgti ,' Non-Residential
Southold, New York 11971 �$
0
Telephone ►�
•
(516) 765-1801 1
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- for -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE O e
OWNER NAME: 14/ De bi7S9/ Li
OWNER MAILING ADDRESS: Z 170 H ICTHl-Ai°fj) 0Au> fd/3 l8 0
Gukr' N • II935 '
OWNER PROPERTY ADDRESS: ?, 2:1 o !-1 6 C 1-i1-del-N4 JI�(0 AD
Cu1c.j4o 0-v A )4.y /1 435-
OWNER TELEPHONE NUMBER: / 3 4t r' '7 'f 4 7� 3
TAX MAP NO. : Section 10 V Block 23 Lot a, 7 r,
CROSS STREET:"3C-/we. ty 5 TU R3b,. `L' U®c,,4i�t �--/�i`� 1� �P & _ ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New - - Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: JRSTI-QNL j (413/51
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.)
.natu'Applicant
RECEIVED BY Mc--72 �� J
Town Clrerk's Offi e
DATE:
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