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JUDITH T. TERRY ' r n' �^ Town Hall, 53095 Main Road
TOWN CLERK = s```_" P.O. Box 1179
a `r Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ter.,t _ �! Fax (516) 765-1823
MARRIAGE OFFICER ` ®dd'9,.t " c‘tr®��1� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER z> � yp7n p to.
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. 3289-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner CRON, RICHARD
Mailing Address 1 JONES, ALLEN (CONTRACT VENDEE)
Mailing Address 2 67 WESTMINSTER DRIVE
City St Zip SHIRLEY NY 11967-0000
Property Address 1 FARMVEU ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-395-5178
Tax Map No. section 121 .00 block 7 lot 4.000
Cross Street HARVEST LANE
Issue Date: 12/07/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
is Of,.-
OFFICE OF THE TOWN CLERKc3(7
Town of Southold .�
Application No.
Judith T. Terry, Town Clerk ` �� :`� :�
Town Hall, 53095 Main Road f. :4 $10.00 - Residential
P. 0. Box 1179 cn _• T "Ai �' $25.00 - Non-Residential
V� a .^t .f�:��r.i �' ,�`
Southold, New York 11971 O .$
Telephone Q( I .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
k: -
for
SEPTIC A K or CESSPOOL
Operation Permit No.
Fee $
DATE j : - t-°/"'f
OWNER NAME: L'/z0„ & LI
OWNER MAILING ADDRESS: (7 fri,P)T „.5 i4, Q,, S'%il/y J'I, //9w7
OWNER PROPERTY ADDRESS: jcm - Dr
r✓� • Ado i1 4.1
OWNER TELEPHONE NUMBER: 73el-3-mv• (/4jk To,,, e/-4139S-'S/7 ')
TAX MAP NO. : Sectionff / /,pp Block '7 Lot t7 000
CROSS STREET: F j1apVtS7 4,e
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New ?/ Existing
Residential v/ 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.)
Signat Ire of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: