HomeMy WebLinkAboutCrepezzi JUDITH T. TERRY 4 vvvGg tTown Hall, 53095 Main Road
TOWN CLERK ® a P.O. Box 1179
Rr5 s: Southold New York 11971
REGISTRAR OF VITAL STATISTICS %�
MARRIAGE OFFICER � - �i�' Fax (516) 765-1823
�� � Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER _ i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3237-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner CREPEZZI, GERALD AND KATHLEEN
Mailing Address 1 P. O. BOX 385
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 455 NORTH DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9354
Tax Map No. section 106.00 block 6 lot 19.000
Cross Street BAYVIEW AVENUE
Issue Date: 8/16/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I Sem
„OFFICE OF THE TOWN CLERK
Town of Southold � CQG" Application No. ;f 7
Judith T. Terry, Town Clerk `
Town Hall, 53095 Main Road - $10.00 - Residential
p. O. Box 1179 � z ' �' $25.00 - Non-Residential
Southold, New York 11971
Telephone = .( •
'�.
(516) 765-1801
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE Tr" /4-1
OWNER NAME: >°1^ale,r cf- iC,/r71 Lee, C��p�� Zz�'
OWNER MAILING ADDRESS: P. de g `3kr-
AY , 1,
OWNER PROPERTY ADDRESS: 1c //P,0,3-1/P,0,3-117, A--
OWNER TELEPHONE NUMBER: S/A6 2 qZ 3
TAX MAP NO. : Section /06 Block Lot L�
CROSS STREET: j5, ytW 4'1/"��
TYPE OF SYSTEM: Septic Tank (V 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.)
Sig ature o / cant
RECEIVED BY: /17-f
•
Town Clerks Office
DATE:
MR. & MRS. G6RAED>'M. CREPEZZI
P. O. BOX 385
- - - - - 455 NORTH DRIVE
SHORE ACRES
MATTITUCK, NY 11952
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