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JUDITH T.TERRY � t '' r`^;, � Town Hall, 53095 Main Road
TOWN CLERK i P.O. Box 1179
0t Southold New York 11971
4*
REGISTRAR OF VITAL STATISTICS �� v O •""' '
MARRIAGE OFFICER Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER `: 491 •1°10 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ''0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3717-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner PRIZEMAN, JOHN
Mailing Address 1 131 HICKS STREET
Mailing Address 2
City St Zip BROOKLYN HEIGHTS NY 11201-0000
Property Address 1 ROCKY POINT ROAD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 718-624-0386
Tax Map No. section 21 .00 block 4 lot 13.000
Cross Street SOUND AVENUE
Issue Date: 11/03/97 Judith T. Terry
• Southold Town Clerk
•
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •c.3\\VFQ(x %
Town of Southold ,i + eaZ.11 Application No.3 7,1
Judith T. Terry, Town Clerk 0 .. ; , W,f' �`l $10.00 - Residential
Town"Nall, 53095 Main Road ,# a , ' -
P. O. Box 1179 cry c `�<<sx ` 4` $25.00 - Non-Residential
Southold, New York 11971 O ��$
Telephone -�.( yf 1% • A
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
i
Operation Permit No.
Fee $ /11):00
DATE cq8f 7
OWNER NAME: , ' ,.
OWNER MAILING ADDRESS: /�/ ge2L•?,.d•We•e•-b---
//e-' /may /1a o/
OWNER PROPERTY ADDRESS : _ °'• '/ ��7 ,
OWNER TELEPHONE NUMBER: 7/, --- 7' " 234 '7+ p5 .176 f..?9-13/O
+ TAX MAP NO. : Section v2-1 Block 0 Lot /3.
CROSS STREET: „,a,..e.,..../a.„...
TYPE OF SYSTEM: Septic Tank Nv New / Existing
Cesspool K. New Existing
Residential_ if ;• 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.)
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