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JUDITH T.TERRY %4 1.•
# '��: Town Hall, 53095 Main Road
TOWN CLERK ` P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `
MARRIAGE OFFICER ` ��,�/ Fax(516)765-1823
RECORDS MANAGEMENT OFFICER = .( ®�r�� Fax
(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. 3644-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner IMBRIANO, ANTHONY & GAETANA
Mailing Address 1 136 CLEVELAND AVENUE
Mailing Address 2
City St Zip MASSAPEQUA NY 11758-0000
Property Address 1 32145 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-795-5431
Tax Map No. section 97.00 block 5 lot 7.000
Cross Street COX LANE
Issue Date: 6/06/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
0, �®��FFO` tr
JUDITH T.TERRY 4. t% Town Hall, 53095 Main Road
TOWN CLERK ` P.O. Box 1179
$ Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ;® �1� Fax(516) 765-1823
MARRIAGE OFFICER 1
RECORDS MANAGEMENT OFFICER . ®.( 41.0 �� Fax
(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. 3644-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner IMBRIANO, ANTHONY & GAETANA
Mailing Address 1 136 CLEVELAND AVENUE
Mailing Address 2
City St Zip MASSAPEQUA NY 11758-0000
Property Address 1 32145 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-795-5431
Tax Map No. section 97.00 block 5 lot 7.000
Cross Street COX LANE
Issue Date: 6/06/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
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OFFICE OF THE TOWN CLERK PFFD
Town of Southold • g • "\�CQ Application No.3CW
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road -< $10.00 - Residential
P. O. Box 1179 �K ;' $25.00 - Non-Residential
Southold, New York 11971 4 •
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Telephone( ���
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE c%/De x-199
OWNER NAME:
/04,077/0/../9? & & 7?9,tI,q Jfl)ok"//9Ate)
OWNER MAILING ADDRESS: /36 eG6 6-- 5 D , E
, ,,,5$gpe62-tt r/, N. / //778
- OWNER PROPERTY ADDRESS : 36;744,5 ///0/1)
eu/c/ /e , ,t/.c/
OWNER TELEPHONE NUMBER: 795j 3)
TAX MAP NO. : Section 097 d Block 45, D 6 Lot 40 2 v®C
CROSS STREET: CTX LANE-
TYPE
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.)
•
Signa re of Applicant
RECEIVED BY:
Town Clerk's Office I""
DATE:
r
SURVEYED FOR:-,d VTNOAJy ,e �/Welf•e/44/0
LOCATED AT �‘,/J'CNoai/E , TOWN OF 4.504/7A140L.O , SUFFOLK COUNTY N.Y.
LOT
MAP OF aciE /eEO,cD@l7®E.e7"y , CO. CLK. NO. FILED
SCALE 1" =30' ...
SUFFOLK CO. TAX MAP DATA:- ` _ _ _
DIST./ , SEC.4,7• 0 . _c___________------------10X
® �/ L���
BLK. VOID LOT 0074000 /�
OFFSETS FROM STRUCTURES t
TO RELATIVE FOUNDRY LINES, t
ON SURVEY, ARE FOR A .• 1`.et
SPECIFIC USE ONLY, AND Ai/9, /,wae/AA/O
SHOULD NOT BE USED FOR /�7vJi
CONSTRUCTION OF FENCES c4'0./7'00.E
OR OTHER STRUCTURES h0
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SURVEYED „J/C / /4 1990 BY
WILLIAM R. SIMMONS JR.
P/O BOX 377
JAMESPORT, L. I., N. Y. 11947
'_'��• _ r1 FILE NO.//' e7 PAGE e.3 GRID.,„/-.39
DRAWN BY.