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JUDITH T. TERRY ; - Town Hall, 53095 Main Road
TOWN CLERK O T �. P.O. Box 1179
REGISTRAR OF VITAL STATISTICS `� � Southold, New York 11971
MARRIAGE OFFICER yQ , Fax (516)_765-1823
*boo Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3151-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MAITREJEAN, PHILIPPE
Mailing Address 1 P. O. BOX 888
Mailing Address 2
City St Zip MATTITUCK NY 11952-0888
Property Address 1 ALDRICH LANE EXTENSION
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4856
Tax Map No. section 112.00 block 1 lot 13.000
Cross Street SOUND AVENUE
Issue Date: 11/30/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK sC,'-
Town of Southold � 4 Ql/ Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road _ ! $10.00 - Residential
p. O. Box 1179 cn t105 $25.00 - Non-Residential
Southold, New York 11971 Off® ��`�
5IJC
aTelephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLiCATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ,14/o!/ h/ /99
OWNER NAME: /12,// pjf/- /v) /
OWNER MAILING ADDRESS: L jure/GO,/
/301(7cg& d DRce38
OWNER PROPERTY ADDRESS: S' A g.1- Ge /v l
/SS�,z oicF'
OWNER TELEPHONE NUMBER: 9B 4/6",,-5-6
TAX MAP NO. : Section /'lam Block / Lot /3
CROSS STREET: LiN1J
I
TYPE OF';-SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: O c, " - ,
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 Applica -
RECEIVED \,BY:
Town Clerk's Office
DATE: ��/ 3
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SURVEY FOR ,;`
NORTH ROAD PHILIPPE L . MAITREJEAN - a'-:,''�`Y
STELLAN ' -
K . MA ITREJEA ,:1_;;
TOWN OF SOUTHOLD ,,,�:,..
SUFF. CO. N. Y. GUARANTEEb °''?
PHILIPPE L. MAiTREJE
e MONUMENT ; STELLA, ,,k...MAitt4EJE
SCALE ' I„ = IOO GUARANTEED .TITLE'-b
MAY 9, 1968 AMERICAN TITLE I40110,
FEB. 22,1971 YOUN0AsYotbNG” '``•' �`:
PROFESSI04ki NG1M,iE-,
LAND SURVEYOFtiN.Y.S.LTC:
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