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JUDITH T.TERRY �� _ < Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �1 Fax(516) 765-1823
MARRIAGE OFFICER °4 " %el°.�
RECORDS MANAGEMENT OFFICER _ /)
MARRIAGE
40 `1► ,d Fax
(516) 765-1800
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. 3441-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner CATHOLIC CHARITIES
Mailing Address 1 DIOCESE OF ROCKVILLE CENTRE
Mailing Address 2 90 CHERRY LANE
City St Zip HICKSVILLE NY 11801-6232
Property Address 1 380 ED'S ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-733-7000
Tax Map No. section 78.00 block 9 lot 67.000
Cross Street VICTORIA DRIVE
Issue Date: 2/29/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK i,�FFa
Town of Southold �� �Q Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road a _ $10.00 - Residential r
P. O. Box 1179 cni ;' $25.00 - Non-Residential
Southold, New York 11971hio F$
Telephone - ,( Jr. 00
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
. APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10.00 _ -•
• DATE January 19, 1996
OWNER NAME: Catholic Charities, Diocese of Rockville CentreuaLr -
OWNER MAILING ADDRESS: 90 Cherry Lane
Hicksville, New York 11801-6232
OWNER PROPERTY ADDRESS: 380 Ed's Road
• Southold, New York '11971
OWNER TELEPHONE NUMBER: 7337000
TAX MAP NO. : Section 078.00 Block 09.00 Lot 067.000
A=CROSS STREET: Victoria Drive
TYPE} O,F,,SYSTEM: - Septic‘ Tank -"--- ----New Existing
Cesspool x New Existing
Residential g 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.)
/71/ n
7 AL!
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Sign. e$o pli a
RECEIVED BY „ !�; - _ •
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