HomeMy WebLinkAboutCopertino, John • ,,,iii., _
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ELIZABETH A.NEVILLE ���= 4% Town Hall, 53095 Main Road
TOWN CLERK C - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
V` Southold, New York 11971
`� 4� Fax (631) 765-6145
MARRIAGE OFFICER Oy ��
RECORDS MANAGEMENT OFFICER '/Ql #a1 III 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. 4143-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner COPERTINO, JOHN
Mailing Address 1 P 0 BOX 336
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 725 WILLOW DRIVE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 631-765-3874
Tax Map No. section 22.00 block 5 lot 13.000
Cross Street CEDAR DRIVE
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Issue Date: 5/15/02 izabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK OCA\\FFO(x ` � // ?,
TOWN OF SOUTHOLD �, COQ Application No. % ! J
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
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SOUTHOLD,NEW YORK 11971 i $25.00 - Non-Residential
TelephoneOj * %it, .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. a I t%
Fee $
DATE / o
.
OWNER NAME: t /�7 ee-
Q //1 Q
OWNER MAILING ADDRESS: /° Q 604- 3 3 6
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OWNER PROPERTY ADDRESS: 7,z 5 Ce. ( L L ® CcJ D,
OWNER TELEPHONE NUMBER: 63( 765 3 , 7�
TAX MAP NO. : Section c).‘ Block 0 S Lot / 3
CROSS STREET: C�' ) Da_
TYPE OF SYSTEM: Septic Tank New `' Existing
Cesspool f 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.)
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signature o Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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'HIGHPOINT AT EAST MARION, SECTION TWO, INC. \
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FILE ND, 7755 JULY 13, 1984 \ o WELL
(VACANT)
28 / 1 6 Z.
, , .R' TO 'HIGHPOIN T AT EAST MARION, SECT ION i
,-IE •:UFFOL K COUNT Y CLERK'S OFFICE ON JAN
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