HomeMy WebLinkAboutBennardo 4010`,,,`/
ri Town Hall, 53095 Main Road
a O �$ P.O. Box 1179
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JUDITH T.TERRY = I �Ls' 0, TELEPHONE
TELEPHONE
TOWN CLERK � (516) 765-1801
REGISTRAR OF VITAL S I ATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 776-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New X Existing
Name Of .Owner BENNARDO, MICHAEL
Mailing Address 1 1 GILBERT LANE
Mailing Address 2
City St Zip PLAINVIEW NY 11803-0000
Property Address 1 510 CRESCENT LANE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-681-5444
Tax Map No. section 30.00 block 2 lot 31. 000
Cross Street THE GREENWAY
Date Of Last Pump Out 0/00/00
Issue Date: 8/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I ��I
OFFICE OF THE TOWN CLERK �eOW.„"
Town of Southold o�. , , 4QG'` Application No.
71
Judith T. Terry, Town Clerk ` o►
Town Hall, 53095 Main Road 1. l' 4f :4 Residential
P. O. Box 1179 v' .;y ' Non-Residential
Southold, New York 11971 a$ ‘� �'' �r`
Telephone .' [qi ^
)2, 1--/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
, • for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE -7 /2-4, leg'
OWNER NAME: M I C1 - - ?ipilLt ly n- - V
OWNER MAILING ADDRESS: t 01 X13 , T L tvn
PLatvi� 1i,uu i.I . , 11gb3
OWNER PROPERTY ADDRESS : 510 E,s L474- Lir -
._ :0/ Sililld ili,04 j flo 'y • !1 '7 3 7
OWNER TELEPHONE NUMBER: 10g, S- 'f
j TAX MAP NO. : Section 3 n-o Block 2_ Lot 3 i
CROSS STREET: -1-1,,,_ atem.A.-4-1
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ( New J)( Existing
Residential F Non-Residential
DATE OF PREVIOUS PUMP-OUT: (_J/4
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.)
C
iii.fit re o Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
T am familiar with the Standards for _
Approval and Con-
- structj an of Subsurface Sewage Disposal. Systems for-
.
family Residences and wi11 abide by.`tfie condi -
; - ) ' tions set, forth therein and n the
permit to construct.
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