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ELIZABETH A.NEVILLE ® �:e Town Hall, 53095 Main Road
TOWN CLERK y 2 P.O. Box 1179
V $ Southold,New York 11971
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REGISTRAR OF VITAL STATISTICS : 1
� 11 Fax (516) 765-1823
MARRIAGE OFFICER _ 471 �ill Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER .0'1��
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. 3818-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner CAFARO, LAWRENCE/KERR, JESSICA
Mailing Address 1 135 ISLAND VIEW LANE
Mailing Address 2
City St Zip CREENPORT NY 11944-0000
Property Address 1 135 ISLAND VIEW LANE
Property Address 2
City St Zip CREENPORT NY 11944-0000
Owner Telephone No. 516-477-1216
Tax Map No. - section 57.00 block 2 lot 31 .000
Cross Street BAYSHORE ROAD
Issue Date: 9/16/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICE 0:1 THE TOWN CLERK c3gFO(,(4.
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'TOWN OF SOUTHOLD �� 441i,
Application No.
O �ilr "rl
ELIZABETH A. NEVILI,Ii,'TOWN CLERK5 10.00 Residential A� �•'�� $
P.O. BOX 1179 `
� ' ` .i,�'`' ., �� $25.00 - Non-Residential
-SOUTHOLD, NEW YORK 11971 ® `�0� •/�
Telephone 1 ••
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /� %'
DATE /l oi/
OWNER NAME: \/-1,kl,SVA-1`1CC� A ` Ckfgs l `"1' 36r- I (4' ka(r _ C
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OWNER MAILING ADDRESS: /5'( L-A-/ V16.) a r
CR-e-eAA6A- , kn 1( ciVY
OWNER PROPERTY ADDRESS: (i
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OWNER TELEPHONE NUMBER: (314 Gf - I 6
TAX MAP NO. : Section �4--- Block DN Lot
CROSS STREET: gkV/g6 ✓C C:' ,aGla
TYPE OF SYSTEM: Septic Tank ` New Existing
Cesspool New xis -g
Residential Non-Residential 1 A,
DATE OF PREVIOUS PUMP-OUT: (A -4 1 � 1` ,n� 1
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.)
Sig -ture of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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