HomeMy WebLinkAboutStapon ••,®.ASAPFOIIrC-
JUDITH T.TERRY t4.
: Town Hall, 53095 Main Road
TOWN'CLERK Z P.O. Box 1179
el3V . n7 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS • O
MARRIAGE OFFICER `� ��f°� Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER = .( *1; �� 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. 3624-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner STAPON
Mailing Address 1 C/O ELE DEVELOPMENT CORP.
Mailing Address 2 P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1865 GABRIELLA COURT
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 108.00 block 4 lot 7.054
Cross Street ELIJAH'S LANE
Issue Date: 4/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK •cl\VFQUr-'--
Town of Southold �� COG?, Application No.
Judith T. Terry, Town Clerk ��� r,i y
Town Hall, 53095 Main Road f. . °'..•��% 7 $10.00 - Residential
P. O. Box 1179 Cl) $'i ' - $25.00 - Non-Residential
Southold, New York 11971 O e�`
Telephone Vial—
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ I
DATE 4 111 `qF
OWNER NAME: S-4—a p 0 r0
OWNER MAILING ADDRESS: SI t S C--) Z,J►2.1 s_1 ( Cl C.:+--.
M a__ -1 c_k , [I!. ( u 19 S2
OWNER PROPERTY ADDRESS: S IHr3''Y'1e.
OWNER TELEPHONE NUMBER: , 1
TAX MAP NO. : Section I C5� - 1 Block Lot `7 • SL4
CROSS STREET: EI ;j pi k '3 La9-k)c_.
TYPE OF SYSTEM: Septic Tank New Existing
✓ New
CesspoolExisting
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.)
et of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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.. S', ` o FILED OCT. 8, 1996 FILENO. . 9912
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TOWN OF SOUTHOLD
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- �� APPROVED cnv.......L ............. w.r.c,, 7 l 7
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:. J°� YEARS FROM DATE OP
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