HomeMy WebLinkAboutMercurio i.
JUDITH T.TERRY • �s•
a: f #� Town Hall, 53095 Main Road
TOWN CLERK ; - _ P.O. Box 1179
_}a � Southold,New York 11971
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REGISTRAR OF VITAL STATISTICS ,
MARRIAGE OFFICER \#.47 moi' ®� tt' Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER = 4 too Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,,i""
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3734-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MERCURIO, LINDA AND WILLIAM
Mailing Address 1 2305 BAY AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2305 BAY AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8303
Tax Map No. section 144.00 block 4 lot 4.000
Cross Street
Issue Date: 11/28/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 0�FFD
Town of Southold ��� r4 : Application N 97
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 cn �
$25.00 - Non-Residential
Southold, New York 11971 c " ' O���`
•Telephone 'Tell ,1 I� '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /O 157)•
DATE • r ( /x /47
OWNER NAME: I/V M . L,,1) /le C
OWNER MAILING ADDRESS: 672305 6nL( L
144-TT I?Lr c-fe ,�Z--
_ OWNER PROPERTY ADDRESS: l‘?� G/
OWNER TELEPHONE NUMBER: LCO c:;2j�' r3��
TAX MAP NO. : Section / Block Lot V
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
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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
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RECEIVED BY:
R ={s/erk's Office . . - ---
• ,4
DATE: N OV 2 ( 1997
Southold Town Clerk
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