HomeMy WebLinkAboutSantacroce (2) ® Town Hall, 53095 Main Road
JUDITH T. TERRY ,
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r`. Southold, New York 11971
MARRIAGE OFFICER ®� °! Fax (516) 765-1823
�® �! Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3067-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner SANTACROCE, JAMES AND LORRAINE
Mailing Address 1 P. O. BOX 302
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 945 TUTHILL ROAD EXTENSION
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2413
Tax Map No. section 55.00 block 6 lot 15.062
Cross Street MOCKINGBIRD LANE
Date Of Last Pump Out 0/00/00
Issue Date: 7/21/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i -
OFFICE OF THE TOWN CLERK •COFO(,r = ..g.06,7Town of Southold �� •- CQG Application No.
Judith T. Terry, Town Clerk . r' . �
l $10.00 - Residential
Town Hall, 53095 Main Road c •''
.G
P. O. Box 1179 cr3 �; �.- $25.00 - Non-Residential
Southold, New York 11971 O ®t` t
Telephone =49,0141: 0,09.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT ,
APPLICATION
for
OPERATION PERMIT
SEPTIC•TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE ro q/e?),.3
OWNER NAME: ----- --/Y71/6"5" /off>AiE -%f v1c2.oce
OWNER MAILING ADDRESS: Go,' 3
O -/ // AJ i(q 7/
OWNER PROPERTY ADDRESS: i.7. re-- 7i://r#777 t -ft:
sZ6 i(97/
OWNER TELEPHONE NUMBER: 6-76) 76s--
TAX
6 -TAX MAP NO. : Section j -(p Block - TE-.49 Lot *6(0
CROSS STREET: /19DCL'6%Jy 4)29 -
TYPE OF SYSTEM: Septic Tank }L New > • Existing
Cesspool x New x Existing
Residential )(' Non-Residential
DATE OF PREVIOUS PUMP-OUT: A7/A
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to built-lino and closest road.)
iLt �.
roket. oat .
Signaturb of Applicant
RECEIVED BY: Si). Com¢ i
Tow Clerk's Offic,
DATE: 7 - a/- 93
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