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ELIZABETH A.NEVILLE ��� -A; Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(516) 765-1823
MARRIAGE OFFICER Vt✓ ®���� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER ®�
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. 3799-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner TANASOV, LAZAROS
Mailing Address 1 1850 ROCKY POINT ROAD
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 1850 ROCKY POINT ROAD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-1438
Tax Map No. section 31 .00 block 2 lot 11 .000
Cross Street ROUTE 25
Issue Date: 7/13/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
00 I, , _i
OFFICE OF THE TOWN CLERK FO(,r
TOWN OFSOUTHOL,D0�� CSG Application No.3 / 7
ELIZABETH A.NEVI!.!F, I AWN CLERK �IA $10.00 - Residential
P.O.BOX 11979 `
SOUTHOLD,NEWYORK 11971 � $25.00 - Non-Residential
-- Telephone - �,( * Y►��i'�
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLI CAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 1 1)S}Cif
OWNER NAME: / 5
OWNER MAILING ADDRESS: 13,93 ,y g , ,.
- MAR-1,0,Q . 11
,OWNER=-PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: -- ,,- 1-11°1.-V41>r
TAX MAP NO. : Section 11 Block Lot ' I
CROSS STREET: eU ,UTE
TYPE OF SYSTEM: Septic Tank 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.)
j Signature of Applicant
RECEIVED BY: ._L ' -`
To n Clerk's Office
DATE: //-3
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