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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® rT, P.O. Box 1179
y: Southold, New York 11971
REGISTRAR OF VITAL STATISTICS VL �. �� Fax (516) 765-1823
MARRIAGE OFFICER '_ ,„, 0® ',. Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER _-7®1 sit
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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. 3222-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner LI EB VINEYARD
Mailing Address 1 P. 0. BOX 907
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 14990 OREGON ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-4075
Tax Map No. section 84.00 block 2 lot 1 .000
Cross Street BRIDGE LANE
Issue Date: 7/13/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'COFair
Town of Southold Application No.h a �2Z
Judith T. Terry, Town Clerk . r ' t , . � y
Town Hall, 53095 Main Road Y' $10.00 - Residential
P. O. Box 1179 �_ ► ` $25.00 - Non-Residential
Southold, New York 11971 O` gab n �O_•�I"
Telephone ( ild
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT •
SEPTIC TANK or CESSPOOL
Operation Permit No. 961 R
Fee $ ' 10 .00
DATE _limp 1 , 1994
OWNER NAME: Lieb Vineyard
OWNER MAILING ADDRESS: P .O. Box 907
Cutchogue, New York 11.935
OWNER PROPER'T'Y—ADDRESS: 14990 Orea-on Road
Cutchogue, New York
OWNER TELEPHONE NUMBER: 734_4975
TAX MAP NO. : Section 84 Block 2 Lot 1
CROSS STREET: ' Bridge Lane
TYPE OF SYSTEM: Septic Tank X New X Existing
Cesspool x New x Existing
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: na
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
GARRETT A . STRANG, ARCHITECT
RECEIVED BY: /4
Town Clerk'kOffice
DATE: -6/9 ��
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