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HomeMy WebLinkAboutBassolino OFFICE OF THE TOWN CLERK • 'of Rte Town of Southold 1 D� r � Judith T. Terry, Town Clerks J' Town Hall, 53095 Main Road ;_ M P. O. Box 1179 %.°"3 ` Southold, New York 11971 ,04„J46 Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL • Operation Permit No. 95 Residential XX Fee $ 10.00 Non-Residential Septic Cesspool XX NAME OF OWNER: Robert Bassolino OWNER MAILING ADDRESS: 28-55 214th Place Bayside, New York 11360 OWNER PROPERTY ADDRESS: 935 Shore Road, House 7 Greenport, New York OWNER TELEPHONE NUMBER: 718-255-9161 TAX MAP NO. : Section 47 Block 2 Lot 22 CROSS STREET: Silvermere Road TYPE OF SYSTEM: Septic Tank xx New Existing xx Cesspool New Existing Residential XX Non-Residential DATE OF PREVIOUS PUMP-OUT: None • Judith T. Terry/' Southold Town Clerk DATE: October 17, 1986 (TOWN SEAL).-‘,2 _ t 1 Y OFFICE OF THE TOWN CLERK cOFD(,r Town of Southold &\% , CQG: Application No. 96 • Judith T. Terry, Town Clerk * r•. ::-t ; �'1Residential Town Hall, 53095 Main Road g P. O. Box 1179 tri r.,;','''. '= tri ; Non-Residential Southold, New York 11971 1.W" • '' • '$ Telephone -40.4 071 (516) 765-1801 RECEIVED TOWN OF SOUT OLD OCT lC 1996 SOUTHOLD WASTEWATER 'DISPOSAL DISTRICT Town cterk South0ld APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL - Operation Permit No. 93_ Fee $ in - ' • DATE T 17i 1166' OWNER NAME: j_,©}12ZT Lam(, NO OWNER MAILING ADDRESS: 2 8 0 . 2 L 4114 PL�, Y (bF-, H .Y. I1 %.O OWNER PROPERTY ADDRESS: q35 5 P-Ef 126A437WoU5F.7 6P-tEI t2,-r N.Y I lc/44- OWNER TELEPHONE NUMBER: 7 1 -- 22S-- e1/4 TAX MAP NO. : Section 47 Block 2 Lot 2 a CROSS STREET: I 1.-N7e hr( RYD TYPE OF SYSTEM: Septic Tank X New Existing X. Cesspool New Existing Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: j i-i1F- 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.) -1/7- 00'.,- ,- • ignature of Applicant Nom` RECEIVED BY: Via, ,• -61--c ) Town (Clerk's Office DATE: C v u.) /7, /M, -. --- _�� - 6 _Q = _ 1✓PiL_c--Tarlo- - .° 24- -o� I 9 -- o , =L= SLY.==__ b5- 0 -- - - -- ' i