HomeMy WebLinkAboutBoccia c t!IJL ®
fprt
JUDITH T. TERRY •4'2 ; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = 1
MARRIAGE OFFICER �` Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER 6 oe Telephone (516) 765-1801
FREEDOM OF INFORMATION OFFICER �t/ �ll
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3240-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner BOCCIA, EDWARD AND MADELEINE
Mailing Address 1 600 HARPER AVENUE
Mailing Address 2
City St Zip WEBSTER GROVES MO 63119-0000
Property Address 1 4520 PEQUASH AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-2534
Tax Map No. section 110.00 block 3 lot 30.000
Cross Street FLEETWOOD ROAD
Issue Date: 8/16/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
'OFFICE OF THE TOWN CLERK FULA-
Townown of Southold � CQ ,� Application No.
Judith T. Terry, Town Clerk �
✓
Town Hall, 53095 Main Road .� $10.00 - Residential .
P. 0. Box 1179 � " h= p
$25.00 - Non-Residential
Southold, New York 11971
Telephone -lei "
" NW"\r���
(516) 765-1801
TOWN OF SOUTHOLD
RECEIVED
AUG 1 71994 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Tonin Clerk Southold
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
•
%j /9.91
OWNER NAME: ED0912_D 4l7f}Die 4,640E E3 c1-40
OWNER MAILING ADDRESS: # 600 ,/,1,c t ie AXE.
/06135 T//2 C 726 kms} 49 , 63//9
OWNER PROPERTY ADDRESS: 512U PEOim 51-1 / dr"
C(QTc H 6-0E, /`I . 7- /193,3'
OWNER TELEPHONE NUMBER: ,5/44-73.5(-25-9•54 - 06A/- 3/x-9602-Sal 'MD >
TAX MAP NO. : Section //d Block 3 Lot 3
CROSS STREET: b7p0J> /zP.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New V Existing v�
Residential r/ Non-Residential
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.)
Signature of Applicant
RECEIVED BY: k
Town' C erk's Office
DATE: ����
- ,
.
. , .
. ,
•
, I'
. 'Y 5;2 o P •op/9 5/,' A K g. ,, A
,
C
-OTC14-06-0E1Y 7
. ,
,
.
, -le),9TER.
, .
0
0 I-ID c,a.ss pooL G-FIRA = -
.
, K.
, . , , _ - --ti -
-11 '- - I ,
r-7- - Ea Hcios E 5 , - 4'1
. „
, .
'il IV 6E.5sPoo t. :-- ,
t .
—A— .
. .51 ,
.
. ...
' ..
- -.--t
.
. .
\(
, , _ i
S S
, .
- .
. ,
. .
, . . .
. . . -
. .
. ,
- - ocahq • .
- //0- ..
. . _. ,
. '
. ,
' ,