HomeMy WebLinkAboutFevola JUDITH T.TERRY "_ r � Town Hall, 53095 Main Road
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TOWN CLERK rtw P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ® 1 $ Southold,New York 11971
MARRIAGE OFFICER *V�Cii si r' �1� Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER : ®4 • 00Telephone(516) 765-1800
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. 3687-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner FEVOLA, RICHARD
Mailing Address 1 755 HARBOR LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 755 HARBOR LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-2519
Tax Map No. section 97.00 block 6 lot 8.000
Cross Street
Issue Date: 9/12/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c3IFU(�(� -
Town of Southold , 0�� CQG Application No. J r
Judith T. Terry, Town Clerk Z
Town Hall, 53095 Main Road a -� $10.00 - Residential
P. O. Box 1179 • r ��' $25.00 - Non-Residential
Southold, New York 11971 ` 1 oc-oe
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Telephone 4
(516) 765-1801
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ \ Qi0• O
DA T
OWNER NAME: Q., 112:>1�C::;5Z.
OWNER MAILING ADDRESSMSS
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OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: --)/114, —
TAX MAP NO. : Section gi Block � Lot B
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing 3
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.)
411h
Signat e Ap'licant
RECEIVED BY:
Town Clerk's Office
DATE:
7/(A7