HomeMy WebLinkAboutBartolacci I l�
.\ t :, ' :;L
fi Town Hall, 53095 Main Road® c # ��� P.O. Box 1179
"`-----:41-_(6249,AY �� �� Southold, New York 11971
JUDITH T.TERR ,,,,, �� FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1140-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BARTOLACCI, A. RALPH
Mailing Address 1 BARTOLACCI, VALERIE A.
Mailing Address 2 523 N MIDLAND AVENEU
City St Zip UPPER NYACK NY 10960-0000
Property Address 1 PECONIC BAY BOULEVARD
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-358-6549
Tax Map No. section 128.00 block 4 lot 14.002
Cross Street BIRCH DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 6/12/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
4
OFFICE OF THE TOWN CLERK COFPO( -
Town of Southold Application No. /4
2/0
Judith T. Terry, Town Clerk sA
Town Hall, 53095 Main Road y Residential
P. O. Box 1179 v' `_ `-¢n ;' Non-Residential
Southold, New York 11971 O ° ®. ' '
Telephonei `j►�� '•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /
DATE 6 "' 6 8 9
OWNER NAME: A. t V.A. B /4i- rG L,4CC-j
OWNER MAILING ADDRESS: 5 2 3 /V /-1 i b L,4--Ai 4- v
u f e&r. •- i 6 p&
OWNER PROPERTY ADDRESS: Tpa co c- -/a.
u 4 t>-: 1192/2
OWNER TELEPHONE NUMBER: g/y-3 j 6w-&'-4f q.) S--/6 /2, 9
TAX MAP NO. : Section l ' 9 Block L./ Lot /'�/,;
CROSS STREET:
TYPE OF SYSTEM: Septic Tank i New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
114/11111(
ignatu of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
1
9
6e- PY ° X \
/
(..) 4., _ ,-, '2- 41,1.. -"a C7 i 49 '-)Z___ / 0 0
-03
w P
c� 0'
c