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Home My WebLink AboutCaroli JUDITH T.TERRY ® �� Town Hall,53095 Main Road TOWN CLERK • car ; e,+,r - P.O.Box 1179 . / 4' 11 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ® 1 MARRIAGE OFFICER Fax(516)765-1823 � i� 11 RECORDS MANAGEMENT OFFICER ®I ED V os, Telephone(516)765-1800 FREEDOM OF INFORMATION OFFICER .��,,, ,0•"1 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3327-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner CAROL!, JOSEPH & KATHLEEN Mailing Address 1 C/O STRUCTURAL TECHNOLOGY Mailing Address 2 1029 WILLIAM FLOYD PKWY. City St Zip SHIRLEY NY 11967-0000 Property Address 1 BRIDGE LANE Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-281-4800 Tax Map No. section 84.00 block 4 lot 11 .001 Cross Street ROUTE 48 Issue Date: 5/04/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) •• .4;. .I OFFICE OF THE TOWN CLERK SW Mir • Town of Southold , O� �C'Q 't Application No. Judith T. Terry, Town Clerk . *.4; Town Hall, 53095 Main Road ~• ;„ $10.00 - Residential P. 0. Box 1179 to hy;i `' $25.00 - Non-Residential Southold, New York 11971 04,1 hold, NewJig (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 2 5 g Q 2- Cet--06-% OEPT 'Fri-4/M-4) Fee $ 1 •b,° � DATE 5 I� OWNER NAME: . I e.--C-LLT LL r L, �, Y lit Io 0 (moo 6-- / - OWNER MAILING ADDRESS: Op L&'I EL V ID / 9K-Lq lik _ OWNER PROPERTY ADDRESS: ®� (IQ OWNER TELEPHONE NUMBER: C‘---1; V0 S ( —� ©t TAX MAP NO. : Section g ''T Block -1 Lot l I } CROSS STREET: Ll TYPE OF SYSTEM: Septic Tank ,/ New Existing CesspoolNew ✓ Existing I/Y o v3 ielis l9S 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.) ti a-6 / Signature f Applicant RECEIVED BY: Town Clerk's Office DATE: