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01 SOF FOLt
ELIZABETH A.NEVILLLE �• ® �.�� Town Hall, 53095 Main Road
4.
TOWN CLERK P.O. Box 1179
co22 $ Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax'�� Fax(516) 765-1823
MARRIAGE OFFICER . efi ®�/ Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER 411 �i
FREEDOM OF INFORMATION OFFICER ����
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3783-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner KROPF, FRANK J. AND BARBARA K.
Mailing Address 1 P. O. BOX 241
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1820 MARLENE LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4864
Tax Map No. section 144.00 block 2 lot 33.000
Cross Street PECONIC BAY BLVD
Issue Date: 4/16/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
r
'` OFFICE OF THE TOWN CLERK OC���FO(r' •.
TOWN OFSOUPHOLD Off, 3''• ,.�� Application No. 13
243
ELIZABETH A.NEVILLE,TOWN CLERK ' ";.j c�
; t .G 1 $10.00 - Residential
P.O.BOX 11794k..-,„1,,
SOUTHOLD,NEWYORK 11971 y rer, �'��� $25.00 - Non-Residential
Telephone _ ' `" i '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /a
DATE L1// /q �
OWNER NAME: F243pf I- ✓,,-/ pg�, K. Kit beO j
OWNER MAILING ADDRESS: /a. 0. 6 D >e yzi /
/--,42 U c l L /V.,/. /I qi' -5571—d.Z-11 I
OWNER PROPERTY ADDRESS: 1 2-0 �r,9t Le,,y 2,...,9
„ 1---L4 )7"--) 7-I-1. �A /V=/. i 194--- --
OWNER
4OWNER TELEPHONE NUMBER: 5-/G - 2- -- y- -L '1
u
TAX MAP NO. : Section J q q, 0 o Block . Lot 3 3• o e o
CROSS STREET: I, Ccai-i Lel 6� i '3 r-✓D
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.)
/ 3 ' 61/It'i
i •
-ignat •vopr. App icant
RECEIVED BY: L? )
Town erk's Office
DATE: ,ev