HomeMy WebLinkAboutBolletino _of ifIOOOO
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Town Hall, 53095 Main Road
*$ P.O. Box 1179
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01, Southold, New York 11971
JUDITH T. TERRY �'�����"' ►/ TELEPHONE
TOWN CLERK (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. 1079-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner BOLLET I NO, NICHOLAS
Mailing Address 1 670 INTERLAKER LANE
Mailing Address 2
City St Zip NORTH BABYLON NY 11703-0000
Property Address 1 GREENWAY WEST
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-667-9505
Tax Map No. section 15.00 block 1 lot 27.000
Cross Street NORTH SEA DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 4/07/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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TIPPF
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OFVC,,E OF THE TOWN CLERK
Town of Southold C
O '� Application No. /07,
Judith T. Terry, Town Clerk A#14,6-
Town
# "-Town Hall, 53095 Main Road ) Residential i
P. O. Box 1179 cr' `_ i ;' Non-Residential
Southold, New York 11971 '40/
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Telephone 0.( Y► 'e
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICA TION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /07,
aj
Fee $ /0
DATE 4 - 10- 59
OWNER NAME: ;�V /Gi'/O/7P5 .L /PO
OWNER MAILING ADDRESS: 670 `7U7-a// eV
Agri/ 844, rkeva " l/).e/C 1/7M
OWNER PROPERTY ADDRESS: j_ „jr,„
OWNER TELEPHONES/ NUMBER: c5./6 667'
3690
TAX MAP NO. : Section /5" Block / Lot )12‘A
CROSS STREET: YL -h)
TYPE OF SYSTEM: Septic Tank � New CV Existing
Cesspool New Existing
Residential — l/ 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.)
Signat e of Applicant
RECEIVED BY: 4
dam'own Clerk' l Office
DATE: APR 07 V59
' SUFFO,LK CO.•HEALTH'DEPT. APPROVAL
.. , H. S.- NO. .
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,' ` 113 (.1 ,
-,-.6-
I . �1 VAU�h!T) ✓ jto
/ �; _• F STATEMENT OF INTENT.
t--- ' �. I W - THE WATER SUPPLY AND SEWAGE DISPOSAL
� ,� / :160,9;+( to i f� , i ' - - SYSTEMS, FOR THIS RESIDENCE WILL '
. �. ___ __ _�__ __. _ +t ; II W ! d CONFORM TO THE STANDARDS OF, THE. •
\ , .� i2-6".5.-g);mr j ' SUFFOLK.CO:,DEPT. OF HEALTH SERVICES.
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d,-1„...__ P2G?P. f�fLIV� ii iw I- APPLICANT
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,, i� 1°� i r �- ° , Q 1--_.__._ 3� 3 SUFFOLK COUNTY DEPT. OF HEALTH;
�_—•6° __-_— ._ 1__Y to Z4 I I , ;.'5 in f% S-E R V ICES — F O,R APPROVAL OF-
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, 16, ' ; U ' = 1 i -I tli - ' (U 0 i iF CONSTRUCTION ONLY
_ f i ,3i r > �3 ,� DATE: 12--(6, c
.� E ji i 1 a, t }- —'--- — f H. S. REF. NO.: /�a
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_ „ GREENPORT NEW'YORK
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