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JUDITH T. TERRY /4Town Hall, 53095 Main Road
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TOWN CLERK O T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ‘‘‘01,42, Southold, New York 11971 /
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MARRIAGE OFFICER ®� •
01 Fax (516) 765-1823�1ty Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3033-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DICARLO, MILDRED
Mailing Address 1 29 COTTONTAIL ROAD
Mailing Address 2
City St Zip MELVILLE NY 11747-0000
Property Address 1 1035 CALVES NECK ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-692-6104
Tax Map No. section 63.00 block 7 lot 32.000
Cross Street YOUNGS AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 5/24/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
411
. FFFI,CE OF THE TOWN CLERK c�vFFO(,( .
-x C - Application No. ®35
Town of Southold � Application
pp
Judith T. Terry, Town Clerk . :` ;;v, 4: _
Town Hall, 53095 Main Road a g. .- ::, :.. '� i $10.00 Residential
p. O. Box 1179 `` f = =q• $25.00 - Non-Residential
Southold, New York 11971 O 4 rO� ���
Telephone o,( �►� .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for - -r
RECEIVED
OPERATION PERMIT
SEPTIC TANK or CESSPOOL MAY 21 1993
Southold Town Clerk
Operation Permit No.
Fee $ •
DATE .5'/,x/5' -
OWNER NAME: /12 1 L ) E> h , C, m-_,Lo
OWNER MAILING ADDRESS: ,72, CO7-7-VATr}-/L jA- ,!
(v/ eLu/LC E- 10.e /c)2r /12)9
OWNER PROPERTY ADDRESS: / P3-r C 6 Lve,,f ,die c-__
5oo teat. % Al. V . / 7777/
OWNER TELEPHONE NUMBER: SSC, 6 7 L -670/
TAX MAP NO. : Section ( 3 Block 7 Lot 3
CROSS STREET:
TYPE ,OF- SYSTEM: SepticTank New Existing V
Cesspool ' New Existing !/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: GZD.1.3
' 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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ign-ture of Applicant
RECEIVED BY-: • - -
Town Jerk's ffice .-
DATE: < /
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