HomeMy WebLinkAboutGerosa, William le"
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ELIZABETH A.NEVILLE �� ti� y�� Town Hall, 53095 Main Road
TOWN CLERK - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v' i Southold, New York 11971
MARRIAGE OFFICER ``�,s ���1', Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER =_ 701 �a��i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER r� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4131-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner CEROSA, WILLIAM A.
Mailing Address 1 1134 PALMER AVENUE
Mailing Address 2
City St Zip SLEEPY HOLLOW NY 10591-1616
Property Address 1 515 CIRCLE DRIVE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 212-598-8060
Tax Map No. section 21 .00 block 3 lot 3.001
Cross Street AQUAVIEW AVENUE
Issue Date: 2/20/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
yn
,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD /3�
O��FF��CO Application No. /
�.
ELIZABETH A.NEVILLE,TOWNCLERK .� $10.00 - Residential
P.O.BOX 1179 t.
SOUTHOLD,NEW YORK 11971 $25.00 - Non-Residential
Telephone ;Ol 0,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /e)
DATE //S- o?Oaoz
OWNER NAME: , l(t,9/17 (), 6Was."
OWNER MAILING ADDRESS: /.. V lvd-AG"
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OWNER PROPERTY ADDRESS: 373"-- /6- ...?iP/ t- 6-45/ //,
OWNER TELEPHONE NUMBER: /2 5f G‘• 0 O/c/y.7,nie'�
TAX MAP NO. : Section ca/ Block 3 Lot 3. l
CROSS STREET: /94)1479 I// 4 6-,/k�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ' New '/ Existing
Residential 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.)
Csr-7 .p02:7&? I24i71ar
Signature of Applicant
RECEIVED BY: •
Town Clerk's Office
DATE:
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A-A-sT 7g jolt'
William erosa
. Gi 4 el 515 Circle Drive
East Marion
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