HomeMy WebLinkAboutBertini OFFICE OF THE TOWN CLERK � ;F�' �=�(/� ,'
Town of Southold
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Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road c y
P. 0. Box 1179 l, :
Southold, New York 11971 p ® ' �o�-
Telephone 01 lit 1P-
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 498 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER,: Walter R. Bertini
OWNER MAILING ADDRESS: P.O. Box 23
Greenport, New York 11944
OWNER PROPERTY ADDRESS: 1095 Shore Drive
Greenport, New York 11944
OWNER TELEPHONE NUMBER: 516-477-2145
TAX MAP NO. : Section 47 Block 2 Lot 25
CROSS STREET: VILaLter Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential x - Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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udith T. rry
Southold Town Clerk
DATE: November 25, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'rC
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Town of Southold ��' Q ' Application No.
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Judith T. Terry, Town Clerk �� �►
Town Hall, 53095 Main Road _ .
n C } Residential
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P. O. Box 1179 � Non-Residential
Southold, New York 11971 �yA t*' -
Telephone _o1 M1 [ yz0 '�
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE /7 L/ d 7
/
OWNER NAME: //e/W7:17? /
OWNER MAILING ADDRESS: /" O`QJ. 6 PA iY/35#27;
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OWNER PROPERTY ADDRESS: /6 .1)./c9/ai `)A0/til`
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OWNER
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section Block Lot
CROSS STREET: ger. T.�� irge— .6";&"--f— 19-A-9"e-2 fell E
TYPE OF SYSTEM: Septic Tank New Existing /
Cesspool New Existing Y
Residential r Non-Residential
DATE OF PREVIOUS PUMP-OUT: 5 GaJc i Co p7
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.)
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Signature of App icant
RECEIVED BY: 044cct
WECEI\I vn erk'sOffice
DATE: NOV 25187
Town Clerk Southold
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