HomeMy WebLinkAboutBerzolla, Brian /''���
tire v
ELIZABETH A. NEVILLE �t ti� Gy ; Town Hall, 53095 Main Road
TOWN CLERK ` P.O. Box 1179
ti z ; Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER ` /, Fax (631) 765-6145
1
RECORDS MANAGEMENT OFFICER ';_ -4 �a0�'�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ����� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4137-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner BERZOLLA, BRIAN
Mailing Address 1 P 0 BOX 5264
Mailing Address 2
City St Zip ROCKY POINT NY 11778-0000
Property Address 1 300 PAVALLION COURT
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-445-8105
Tax Map No. section 88.00 block 6 lot 13.020
Cross Street WATER TERRACE
Issue Date: 4/02/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
"
OFFICE OF THE TOWN CLERK OC�VF FOLK " -
TOWNOFSOUTHOLD A, 4 Application No. 47//37
11�$� P.O.BOX 1 SOWN CLERK cr3
$10.00 - Residential C./
SOUTHOLD,NEWYORK 11971 ��� $25.00 - Non-Residential
Telephone 0 4 OCel
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
z 9 6 2
DATE
OWNER NAME: '/ / 41`1•7 3 e
OWNER MAILING ADDRESS: *UC /C fd i • f • T
7 7 e�
OWNER PROPERTY ADDRESS: °
v .y_ tog
OWNER TELEPHONE NUMBER: 63 g 0
z
TAX MAP NO. : Section 0 Block (; Lot /3 2 0
CROSS STREET: tC't 7L1 " °Ze {
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool
621w Existing
`: • � 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.)
F
,/72
gnature of Applicant
RECEIVED BY: jia� -�
own erk's Office
DATE: O
e.