HomeMy WebLinkAboutCracchiola JUDITH T.TERRY � t' •� Town Hall, 53095 Main Road
TOWN CLERK = ; P.O. Box 1179
t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
, .V‘ 1�, Fax(516) 765-1823
MARRIAGE OFFICER � � '����' ®� ��
RECORDS MANAGEMENT OFFICER ® Telephone(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. 3484-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner CRACCHIOLA, ANTHONY AND KATHY
Mailing Address 1 68 MONTAGUE STREET
Mailing Address 2
City St Zip BROOKLYN NY 11201-0000
Property Address 1 1300 MINNEHAHA BLVD.
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 718-625-3240
Tax Map No. section 87.00 block 2 lot 11 .000
Cross Street NAKOMIS ROAD
Issue Date: 7/16/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
1 ft. tea.i
OFFICE OF THE TOWN CLERK CIWFDI,t3j
Town of Southold �� , ., CQG,_ Application No.L ��
Judith T. Terry, Town Clerk ���o.,,, ,,..., . :1., y /
Town Hall, 53095 Main Road
_`=_+ . - :C ' $10.00 - Residential r/
P. O. Box 1179 v' hi ;' $25.00 - Non-Residential
Southold, New York 11971 O ' '` ` '' *�1`�
Telephone 4Q( ,-, .- Q oo
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /9'
DATE , / ii I q
OWNER NAME: 4441..itty �/ A',9--/--R-7 6-q6c 6'
OWNER MAILING ADDRESS: / 7414/1:3_ 6c_r_A-11,a4k,_
-- OWNER PROPERTY ADDRESS: /3e3-1) il2A'j1/1"%e__,L,14-e‘.,- ,
OWNER TELEPHONE NUMBER: (7J 5 3a if-c;/v9./) 777-'Oaf
TAX MAP NO. : Section v 7 Block a Lot I'
CROSS STREET: -
TYPE. OF SYSTEM: Septic Tank ' New Existing s
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.)
/ /
Signature if Applicant
RECEIVED BY: /14
LL.Lt <4.-)._Tow -n Clerk'sffice - -
DATE: ' 7/47- /9
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