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Home My WebLink AboutCreato JUDITH T. TERRY F; Town Hall, 53095 Main Road P.O. Box 1179 TOWN CLERK ® w 11, REGISTRAR OF VITAL STATISTICS , .�` Southold, New York 11971 MARRIAGE OFFICER �® .Y' Fax (516) 765-1823 4��® �® �!' Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1899-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner CREATO, DAVID C. Mailing Address 1 P. O. BOX 1149 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 3639 COX NECK ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-9106 Tax Map No. section 106.00 block 8 lot 51 .000 Cross Street BREADWATER ROAD Date Of Last Pump Out 0/00/00 Issue Date: 5/13/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK 0c0FpC,,t'.5.; Town of Southold CQG, Application No. / Judith T. Terry, Town Clerk t„ ; Town Hall, 53095 Main Road -� $10.00 - Residential p. O. Box 1179 � - " ' �' $25.00 - Non-Residential Southold, New York 11971 O ®_ Telephone . (516) 765-1801 TOWN' OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT • APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL , Operation Permit No. Fee $ /C7 DATE :5-;---// — • OWNER NAME: DAVid C C.i -670T-c - OWNER MAILING ADDRESS: A©i/i--4 44 tQ 77(t - -' //l�Z OWNER PROPERTY ADDRESS: . 3b3 S /• // j 2_ OWNER TELEPHONE NUMBER: 2nd, --?/"4' TAX MAP NO. : Section •/d 4' Block T Lot CROSS STREET /. c i tv� �- , . TYPE OF SYSTEM_: - Septic Tank _ ✓- New Existing Cesspool New, Existing k7 • Residential k Non-Residential DATE OF PREVIOUS PUMP-OUT: Z.-92_ LOCATION MAP: Must be attached heretobefore permit may be issued. (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) Signature of Applicant RECEIVED BY: K...c.,y_c_e_<< - - Town: (clerk's ffice - - - - - DATE: RECEIVES. • MAY 12 1g9 Town Clerk Southold • . - • Li\ `I\ n) `D. cf), CT1 ,e=se LV 1., JP"