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ELIZABETH A.NEVILLE t1®� �c Town Hall,53095 Main Road
•
TOWN CLERK 2' P.O.Box 1179
, Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `*fi� ®�'.1 Fax(516) 765-1823
MARRIAGE OFFICER __ ®` • iii Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3806-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner DEGREGORIO, ROBERT & MARYKATE
Mailing Address 1 100 OAK STREET
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 100 OAK STREET
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-4285
Tax Map No. section 136.00 block 1 lot 36.000
Cross Street PIERCE DRIVE
Issue Date: 8/13/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �FFU
Town of Southold ���� �CQ Application No. 3M6
Judith T. Terry, Town Clerk .` • ��
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 �' fir► :' $25.00 - Non-Residential
Southold, New York 11971 0 *.$
Telephone _o.( Allit
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No.
Fee $ \Q
DATE /IZSPS
OWNER NAME: 1.-0\002i• k " `0L2�lLoAn (06 (9e.eppob
OWNER MAILING ADDRESS: \,CO rD
TCCLY (Ci Sar
OWNER PROPERTY ADDRESS: \,000 Off- S- A'
OWNER TELEPHONE NUMBER: 41Sit -4285
TAX MAP NO. : Section V3 Lk, Block L Lot 3l-131
CROSS STREET: QE1c.C.E Due-4/e:
TYPE OF SYSTEM: Septic Tank New Existing V Cesspool New Existing
Residential \77-- 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.)
VcA
Signature ofApplicant
RECEIVED BY:
jakc -k's Office -
7
DATE: