HomeMy WebLinkAboutBerberich '/lig®� et��®i� cre,_\
JUDITH T.TERRY �. ,. Y, ,Q Town Hall,53095 Main Road
TOWN CLERK ; y ,ti ' P.O.Box 1179
� 0 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS U > '�
MARRIAGE OFFICER \420
® �/ Fax(516)765-1823
RECORDS MANAGEMENT OFFICER : 1 114edl 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. 3333-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner BERBERICH, FRANCIS C.
Mailing Address 1 3040 GRAND BLVD.
Mailing Address 2
City St Zip BALDWIN NY 11510-4734
Property Address 1 135 SOUTH OAKWOOD DRIVE
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-223-0514
Tax Map No. section 145.00 block 3 lot 14.000
Cross Street PECONIC BAY BLVD.
Issue Date: 5/16/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK CI\FFULj '
Town of Southold •, . C'QG , Application No.5 3
Judith T. Terry, Town Clerk - y:,
Town Hall, 53095 Main Road :4= ! $10.00 - Residential
P. O. ,Box,- 1179' cn ; $25.00 - Non-Residential '
Southold, New York 11971
Telephone 4Q( * •
�.a� ��• •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
R - APPLICATION
MAY 1 5 1995 � for
Ion Clerk Southold OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ • •
DATE HAI al 19,93
OWNER NAME: VA-GOC LS C. i E, E(? (-
OWNER MAILING ADDRESS: 504o 6-42.A (3LV-t)
co ;do ` !'J L('• (irk)/®- -*7 3
- - - - - --OWNER PROPERTY ADDRESS: 13 c)&)Th DllA.Kuut.o7
L
OWNER TELEPHONE NUMBER: Si (o- l23 - OS I
1 c LSA 4--3 Ssb'C•i
TAX MAP NO. : Section t 4 3 Block Lot f q
CROSS STREET: oc .'-'�"t-" pm00AJIC, (34( Lo� to PECOCOtO /144/
TYPE OF SYSTEM:" Septic Tank 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.)
Signature of Applicant
RECEIVED BY:
.Town Clerk's Office
DATE:
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