HomeMy WebLinkAboutMazzaferro (2) io
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JUDITH T.TERRY �1 _ Town Hall, 53095 Main Road
TOWN CLERK ; y Z ; P.O. Box 1179
1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS O .1% Fax(516) 765-1823
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MARRIAGE OFFICER y�fa� i•0 Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER I `�os
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. 3442-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MAZZAFERRO, FREDERICK AND
Mailing Address 1 KATHRYN
Mailing Address 2 P. O. BOX 159
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 2850 PINE NECK ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2246
Tax Map No. section 70.00 block 10 lot 4.000
Cross Street OAKLAWN AVENUE
Issue Date: 2/29/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•.
OFFICE OF THE TOWN CLERK �F�(�.�'=
Town of Southold �� CQG Application No. 5 Sly
Judith T. Terry, Town Clerk �� y
Town Hall, 53095 Main Road a $10.00 - Residential
p. O. Box 1179 to ' $25.00 - Non-Residential
Southold, New York 11971 c?. .A\"-
Telephone '�f.( jig •
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT -
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
• DATE I A `bi qG
OWNER NAME: f-recitp r'c.k I'(ail-1,11-z - IAZLcCPe rro
OWNER MAILING ADDRESS: e O 1337( i,r9
S o o [4 , /V `/ H 9 '7 /
OWNER PROPERTY ADDRESS:___ g SO Pin /\J ed.( IR c7 cid
Sc Lt*kot4 ) AlY I I9 `7f
OWNER TELEPHONE NUMBER: (5; j„ ) /05 ID-4L
TAX MAP NO. : Section 70 Block / b Lot
CROSS STREET: 0.K l 0.W n A\I'2h u e—
TYPE OF SYSTEM: Septic Tank New Existing u
• Cesspool LJ' 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.)
J/71.)
Signatu e / pplicant
RECEIVED BY: d---/LA,-;1&__ '
Town Clerk's Office . . , . _.
DATE: &tel/9
w ,Fred Mazzaferro
PO Box 159 r'
k" _ 2&2°Pine Neck Rd ��j _
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