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JUDITH T.TERRY
,•�� y� Town Hall, 53095 Main Road
TOWN CLERK Z P.O. Box 1179
�' ; Southold,New York 11971
REGISTRAR,OF VITAL STATISTICS ®� '4��� Fax(516) 765-1823
MARRIAGE OFFICER 4. ® i
RECORDS MANAGEMENT OFFICER ®° J [ '1►',,p Telephone(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. 3700-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner GARVEY, ROBERT
Mailing Address 1 DE SYLVA, PATRICIA
Mailing Address 2 P. O. BOX 25
City St Zip EAST MARION NY 11939-0000
Property Address 1 PRIVATE ROAD #1
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-821-0555
Tax Map No. section 22.00 block 3 lot 4.000
Cross Street ROUTE 25
Issue Date: 10/10/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
GA 4
•
OFFICE OF THE TOWN CLERK '��F�"Q(/�•'=
Town of Southold �� CQ&=* Application No. 3 76
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 $25.00 - Non-Residential
Southold, New York 11971O
Telephone 1
41
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
DATE qi?
OWNER NAME: (R.d 9,e421" 6iR /C Q -t4 Lv4
OWNER MAILING ADDRESS: P 2_4.--
OWNER PROPERTY ADDRESS : � f'OJ-rg, 9-0 a4 447 /
C, rs•� ,"�` //'j
OWNER TELEPHONE NUMBER: . gZ-/ —
TAX MAP NO. : Section Z Block 3 Lot
CROSS STREET: Q—
TYPE OF SYSTEM: Septic Tank �/ New Existing l/
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.)
Signature o` •plicant
RECEIVED BY:
TowNie� g
RPoffice
DATE: OCT 10 1997
SouthAd Town Clear
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TAX DATA:' Tack of Southold
District 1000, Section 22, Block 3, Lot 4
AssessedValue Land and Building: $14,800
1990/91 Taxes, no exemptions: $5,598.79