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ELIZABETH A.NEVILLE I At' s ' , � Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
,° E Southold,New York 11971
REGISTRAR OF VITAL STATISTICS V Q �$ Fax(516) 765-1823
MARRIAGE OFFICER � t � 1�
RECORDS MANAGEMENT OFFICER : �� •®��i� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER -„ i���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3768-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner KRESHON, MICHAEL R.
Mailing Address 1 50 RUTH ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 50 RUTH ROAD
Property Address 2
City St Zip MATTITUTCK NY 11952-0000
Owner Telephone No. 516-298-4024
Tax Map No. section 106.00 block 5 lot 36.000
Cross Street BREAKWATER ROAD
Issue Date: 2/23/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
A -,
I i
OFFICE. OF THE TOWN CLERK �FFO�C
Town of Southold ��� • 4 Application No. ���
Judith T. Terry, Town Clerk i►
Town Hall, 53095 Main Road, • -< ► $10.00 - Residential
--------
. O. Box 1179 cry - ' ��` $25.00 - Non-Residential
Southold, New York 11971 O ,0."
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Telephone O.(
(516) 765-1801
• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 2,i/?v
OWNER NAME: ,,1 lc ' / fr, �d(,tesoc1
OWNER MAILING ADDRESS: 50 / ,od
Ing- 0-c,ck LI 1,13 6L—
OWNER 'PROPERTY ADDRESS:- - -00/7 ,v 5 6esu '--
•
OWNER TELEPHONE NUMBER: 5f - 2.9p, - q q!
TAX MAP NO. : Section /04 p Block -� � Lot —3C
CROSS STREET: pj,4 eocad c., B„" cmc 4,'. 85ac�
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.)
s /
ignature o Applicant
RECEIVED BY: ' ' ' -
Town Clerk's Office
DATE:
E