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ELIZABETH A.NEVILLE o d Town Hall, 53095 Main Road
TOWN CLERK t ti 2 $ P.O. Box 1179
4 ��� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS � ?i o�'�� Fax(516) 765-1823
MARRIAGE OFFICER ;�®,( #00' Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER - W Pi
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. 3816-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner WILLIAMS, JOHN C.
Mailing Address 1 PO BOX 32
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 1820 TRUMAN'S PATH
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-0877
Tax Map No. section 31 .00 block 13 lot 3.000
Cross Street ROUTE 25
Issue Date: 9/16/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERKS�FFOIA-
'TUWN OF SOUTHOLD p%c31
D Application No. 3 I f
ELIZABETH A. NEVILLE,TOWN CLERK $10.00 - Residential ti
P.U. BOX 1179 <•
°fi•� �• $25.00 - Non-Residential
SOUTHOLD, NEW YORK 11971 : 0"/
Telephone Q( ,N
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ( O. Ova
DATE 1 - ILC-9 Ss
'OWNER NAME: 0-0110- CI LA) , I (ca/ S •
OWNER MAILING ADDRESS: P. O • 6o, 3 2.
Fas4ViGrro `l ((9I39
OWNER PROPERTY ADDRESS: IS-20 I ruv ICO' s
Fo„.0-1 • N'p Il 9
OWNER TELEPHONE NUMBER: t- n - OCCrl
TAX MAP NO. : Section � Block 3 Lot 3
CROSS STREET: 5444-e eo uo e 2,c
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential -X Non-Residential
DATE OF PREVIOUS PUMP-OUT: IA VI k ►� o w
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.)
55b1,,i
(3, Go, (// k zi
Signature of A•plicant
RECEIVED BY: sAL/►c_a06,
Tovdn Clerk's Office
DATE: /6, /996
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