HomeMy WebLinkAboutLucarelli , 4f OLS
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK •
® ac P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = � Fax (516) 765-1823
MARRIAGE OFFICER �� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER O,� $0,01
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3271-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner LUCARELLI, CHARLES
Mailing Address 1 350 LUPEN DRIVE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 350 LUPEN DRIVE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7723
Tax Map No. section 104.00 block 1 lot 1 .000
Cross Street SKUNK LANE
Issue Date: 10/26/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c \VFO(,e
Town of Southold 4 C
� -. QG'` Application No.� 2'�/
Judith T. Terry, Town Clerk % , f ,f 0� `�?'1/
Town Hall, 53095 Main Road '4 I $10.00 - Residential
P. O. Box 1179 z $25.00 - Non-Residential
Southold, New York 11971 ��`
Telephone 1 [ Y►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 7/
Fee $ / /7 , v P
DATE /b./5�/Y
OWNER NAME: 'j-var j L1.4-CcU- fL l I(,
OWNER MAILING ADDRESS: 350 4c4.-p 9 `r v
�I0�1„0F � / ! 7,35—
OWNER PROPERTY ADDRESS: ,5: 7n
OWNER TELEPHONE NUMBER: 73Y- 7%?
TAX MAP NO. : Section jay, oo Block > Lot /, 000
CROSS STREET: �/161, k La,,e
TYPE OF SYSTEM: Septic Tank - d/ _ .New C Existing
Cesspool New j Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
i
Signature of • p.licant
RECEIVED BY: /3. ?-��,1
ow Clerk's Office
DATE: /
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