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JUDITH T. TERRY
. 44:1‘
Town Hall, 53095 Main Road
TOWN CLERK G T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS . Southold, New York 11971
y r Fax (516) 765-1823
MARRIAGE OFFICER O ®� •
1D �� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3176-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner GRIPPA, PAUL AND MAUREEN M.
Mailing Address 1 1100 COUNTY ROAD 48
Mailing Address 2
City St Zip MATTITUCK NY 11952-3104
Property Address 1 1100 COUNTY ROAD 48
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5501
Tax Map No. section 122.00 block 1 lot 2.001
Cross Street COX NECK ROAD
Issue Date: 2/24/98/ Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK .l\FFO
Town of Southold �� �Q ' Application No.,;/-7
Judith T. Terry, Town Clerk r $10.00 - Residential t./Town Hall, 53095 Main Road c F
P. O. Box 1179 cn _ . """,* ' ; $25.00 - Non-Residential
Southold, New York 11971 0Z?,, `r-`'
.;t. off- 41
Telephone 0/ A� '0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
DATE �.j'U ri ( /07 /941
OWNER NAME: /PCcetl e A
OWNER MAILING ADDRESS: //D 0 edvw7Ey Au/ i9F
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OWNER PROPERTY ADDRESS: c„..`�;.,i- ' e
OWNER TELEPHONE NUMBER: „On, /
TAX MAP NO. : Section /011) Block /c c Lot
CROSS STREET: &K /VeeA
TYPE OF SYSTEM: Septic Tank AZ. New Existing
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 of Ap. scant
RECEIVED BY: ,--)ccc— I ,
, . II V E wn Clferk's Off c
DATE: -
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