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JUDITH T.TERRY �1�4 oe
?'�: Town Hall, 53095 Main Road
TOWN CLERK Z P.O.Box 1179
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i Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ‘`‘°°*
`®y 41$
MARRIAGE Fax(516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER �.( .a00�
* 0,' Fax
(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. 3550-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner PERRICONE, SUSANNE
Mailing Address 1 1930 LEEWARD DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1930 LEEWARD DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-9372
Tax Map No. section 79.00 block 7 lot 11.5.000
Cross Street TOPSAIL LANE
Issue Date: 11/20/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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FFICE OF THE TOWN CLERK '• FO
Town of Southold .® CD Application No.•3s�d
Judith T. Terry, Town Clerk a'" G
Town Hall 53095 Main Road z' $10.00 - Residential
P. O. Box 1179 �' � � •: ' " Z' $25.00 - Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL •
Operation Permit No.
Fee $ •
DATE I1- IS -` 1.
OWNER NAME: S U SA ev N[= P6712 12 I ed e
OWNER MAILING ADDRESS: lq 3 O G•. t= E-1 6�,� l� Q 1 0e
D 1 t
OWNER PROPERTY ADDRESS: S /9- E.
OWNER TELEPHONE NUMBER: 5 1 (o - 'l S— al 3'1
TAX MAP NO. : Section 7 ? Block 7 Lot 445--
CROSS STREET: -TO ® S H I L- L n1.
TYPE OF SYSTEM: Septic Tank -A 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 Applicant
RECEIVED BY:
Town C0/18117i ce
DATE: NOV 1 91996
Southold Town Clerk
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►we m b % j£�r" 2. �� } SURVEY FOR:
o CD CE 1 ' T - - - ''`, STEPHEN PERRICONE. ;t '
• 0 m.`a_ , ii' • - ' „ <� ; e' ' _' 1 . L0�'NO.48;'LEEWARD ACRES AT BAYVIEW"
.•r _ _ ►: , l: '- Ito _ •�1„ `, - - - ,C AT• ;r BAYVIEW GUARANTEED TO: /
, ,.ij �. r' O.'lr. '\. 1F GUARANTEED TITLE DIVISION OF'• ,
�� SS TOWN of AMERICAN TITLE INSURANCE CO.
1,t i t v ,;?i `'> - O�-- �a b �ti I Y ' - ' SOUTHOLD - STEPHEN PERRICONE _