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ELIZABETH A.NEVILLE �a®�' # Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
- • � __ ::, .,,�__;- m' 4 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS • - �'.< ^_` 117
MARRIAGE OFFICER
'z � '1 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER lits ®� �� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ' ®1 3 16,, to
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3821-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner CASSIDY, JOSEPH & ANTOINETTE
Mailing Address 1 855 CAGEN'S LANDING ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 855 GAGEN'S LANDING ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-58l.9
Tax Map No. section 70.00 block 10 lot 31 .000
Cross Street CLEARVIEW AVENUE
Issue Date: 9/28/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF T115.TOWN CLERK C31FU14 ' '-
TOWN OF SOUTHOLD &.® 3' Application No. 33.21
ELIZABETH A.NEVIJ.J.F,TOWN CLERK 'i -' $10.00 - Residential P.O.BOX 1179 trai l
SOUTHOLD,NEWYORK11971 *.$ $25.00 - Non-Residential
Telephone , $6?,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. "
Fee $ /0:— -
DATE q c„2-19R
OWNER NAME: • bAnT—D704),cg)
OWNER MAILING ADDRESS: gc ; 4 cam, 13 /A i, .,';/ v ....
61, , -.' A. e 1/97)., 4
OWNER PROPERTY ADDRESS: CS;K//711-6
OWNER TELEPHONE NUMBER: _ 7 4 j �I/ .— ;P� '
TAX MAP NO. : Section r7 6 Block 10 Cot 3 I
CROSS STREET: .1' l _ / �i
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.)
adAtiCa-h2- AI
Signature of Applican
RECEIVED BY: l ' r\P -2-
To nClerk's Office
DATE: . (--1 [025 /96-
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