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JUDITH T.TERRY t _; <u y • Town Hall, 53095 Main Road
TOWN CLERK ® s�"` -'
c x .; ; f P.O. Box 1179
tik4; 0 � Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ,� 0
MARRIAGE OFFICER ®�,oft Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER �;��0Telephone(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. 3710-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner ODDON, DAVID J. AND JEANMARIE
Mailing Address 1 655 LEGION AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 655 LEGION AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4104
Tax Map No. section 142.00 block 2 lot 5.000
Cross Street PACIFIC STREET
Issue Date: 10/23/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
r •
Of ice,
OFFICE- OF ,THE TOWN CLERK S�FFOGt�'=
Town of Southold &,% (4% Application No. 9-7/0
Judith T. Terry, Town Clerk ��� r, *%1
Town Hall, 53095 Main Road 8K , , -� $10.00 - Residential
P. O. Box 1179 E' C M ;'
$25.00 - Non-Residential
Southold, New York 11971 Obi ` met
eVe
Telephone j
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. •
Fee $ •
DATE -10
OWNER NAME: ` J�� SU V . + e_A6o®Doq
OWNER MAILING ADDRESS: Co CJLZc (On
N1c I I i _-1�c n ) ICts
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 5 1 G9 2q O �, 10
TAX MAP NO. : Section 4 Z Block Z Lot
CROSS STREET: ��� -RC— S+-re---e-A—
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ew 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.)
SW! : 1/ '
Signature of App icant
RECEIVED BY: /1---
Town Clerk's ice
DATE: / /J` /c /97
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