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JUDITH T.TERRY ►� = s ;' <` Town Hall, 53095 Main Road
TOWN CLERK ; y s: ; P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ''' �� Fax(516) 765-182
MARRIAGE'OFFICER 44 „ ��� .9 3
Telephone(516) 765-3
RECORDS MANAGEMENT OFFICER 1 •j'
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. 3432-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SUCIC, CATHERINE
Mailing Address 1 P. O. BOX 1951
Mailing Address 2 -
City St. Zip SOUTHOLD NY 11971-0000
Property Address 1 2615 KENNY'S ROAD -
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. - 516-765-5719
Tax Map No. section 59.00 block 7 lot 3.000
Cross Street SOUNDVIEW AVENUE
Issue Date: 2/13/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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IFI
CSCE OF THE TOWN CLERK C.3\\V
Town of Southold O CQG= Application
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road 1 $10.00 - Residential Q�
• P. O. Box 1179 u3
$25.00 - Non-Residential
Southold, New York 11971
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Telephone0,( , %`
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE „/��7�j
OWNER NAME: e.g-r,,,le-g,aL�C�
OWNER MAILING ADDRESS: pQ 6 C.;° ' iq5-- J
_‹,6,,thn ld ,,uy 1/9-7 /
OWNER PROPERTY ADDRESS: _ ,,j/.5a ����s
f/q-71
OWNER TELEPHONE NUMBER: 7663 3-7/q
TAX MAP NO. : Section
5-9 — Block 7 Lot
CROSS STREET: , 1 . /
TYPE OF SYSTEM: ; ,Septic TankI _ 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.)
Signat re of Applicant
RECEIVED BY: 'Vl /2-;tr-0110• •Town. Clerk's • ffice
DATE. ��/ 9/6i _
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KENNEY 'S ' ROAD
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