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JUDITH T.TERRY � • Town Hall, 53095 Main Road
TOWN CLERK g P.O. Box 1179
REGISTRAR OF VITAL STATISTICS : ® �' r tV
"P Southold,New York 11971
MARRIAGE OFFICER 4;1 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER : ^� * ifd Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER .�•-a
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3733-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MACARI, JOSEPH
Mailing Address 1 36230 MAIN ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 36230 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-4071
Tax Map No. section 97.00 block 3 lot 1 .000
Cross Street SKUNK LANE
Issue Date: 11/25/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
f
OFFICE OF THE TOWN CLERK ,c3VFFOte:-
Town of Southold .\V c.,:v Application No. 783
Judith T. Terry, Town Clerk .` - - y j
Town Hall, 53095 Main Road ` ~ $10.00 - Residential
P. O. Box 1179 `^.. - ►i ;) $25.00 - Non-Residential
Southold, New York 11971 O••&_ ':,c.,\--•••
Telephone Telephone ,( * `1► '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for 1
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 0/ )1.)---
.
OWNER NAME: JOS-Q E 0\VA(
4
OWNER MAILING ADDRESS:(' a2Q a-\, 1\ l 0 RD
tkipc) u /_:_k) \I - ) 1 q a_ .
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: Alp-) -33 ii ® -04-1
TAX MAP NO. : Section L{73 61 Block q 1 . Lot -3 - /
CROSS STREET: A & t v\ e..6, 1 SK ,�
TYPE OF SYSTEM: Septic Tank New Existing
r1 _, ,,," y
Cesspool "' - t 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.)
A. t ant-0(16k-OLCCL --;
ignature of Applicant
RECEIVED BY:
Town Cl rk's Office
......z.zezdet3y'. . _RECEIVED _
DATE :
_
N OV -25 1997
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