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ELIZABETH A.NEVILLE t® .4.;c" `,y Town Hall, 53095 Main Road
TOWN CLERK ® }f ; P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �` �'I Fax (516) 765-1823
MARRIAGE OFFICER �1 TeleP hone(516) 765-1800
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RECORDS MANAGEMENT OFFICER `'IAN"
FREEDOM OF INFORMATION OFFICER .�®l *s.'
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3823-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MALPIEDI, CHARLES
Mailing Address 1 26 MAYFAIR AVENUE
Mailing Address 2
City St Zip FLOARAL PARK NY 11010-0000
Property Address 1 150 OLD FIELD COURT
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-1634
Tax Map No. section 120.00 block 3 lot 8.028
Cross Street FARMV I EW ROAD
Issue Date: 10/21/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
}OFFICE OF THE TOWN CLERK
__ 'S�FFDC,�.
-1 , TOWN OF SOUTHOLD ��� COG Application No. 3�0?,3
ELIZABETH A. NEVILL}:,'TOWN CLERK ~ �� $10.00 - Residential ,-
P.O. BOX 1179 v' ` ` i ; $25.00 - Non-Residential
SOUTHOLD, NEW YORK 11971
Telephone *0Off- ��`
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1 .?rGR
Fee $ ) o•, Db
. DATE 4� /�Y
OWNER NAME: CHa?in r--)Hzel ec)
OWNER MAILING ADDRESS: , oma & my ' ,tzl
12U2ea, come ivy /I 0,0/
OWNER PROPERTY ADDRESS: ISD OLP L!.p ci-
riovi TVcl< /J y 05-7,
OWNER TELEPHONE NUMBER: 2. 16- /63L/
y TAX MAP NO. : Section M0, 0 Block j Lot U , D Z 8)
CROSS STREET: PgrldieV tri DAD
TYPE OF SYSTEM: Septic Tank V New V Existing
Cesspool I/' New i/ Existing
Residential / Non-Residential
DATE OF PREVIOUS PUMP-OUT: P 1
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, t building and closest road.)
1 1( ,
Signa e of Applicant
RECEIVED BY: AE
Town Clerk's Office
DATE: 16 1 9 (c
i
-.�w( /-2.-Lo ------ Re
ST_TH:OLI< OUN i 1 DEPARTh1ENfT OF HEALTH SERVICES I SuiYolk County
A?P'4.O�� L Ok CORSTRUC r WORMS FOR SEP 2 5
A 4Ir:G~.E ANVIL Alf. - 1998
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.: t.,: 'V 0 7 1_ TIS act:No. i'_(IIOO �—� ��f„apt Of�� �t�, o��s
`” O -«Ce Of(1Vaste a .r Mgmt.
Thu sewap disposal and water supply facilities at this (caution have.been C `L
r1. meed and/or'.:,:tifie i by 0,,s Dcp cr or otirr agencies nod fo, d to
L'.,sa.'"}a,tory FOR if,-c��A I;AI :_O 4':Yr:2,R90M.S.
- .r'iteid)tcil A.Cr',t .P.i';.icf
Ofil,.`•of'Water and Wastewatergement
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IST. ( 2)
I�rl� ►—a – IC,
DLA-- 12Fh VALA,I( OGC-.-ab
THE LOCATION OF WELLS,WATER SERVICE -
LINES, SEPTIC TANKS AND CESSPOOLS '
SHOWN HEREON ARE FIELD OBSERVA-
TIONS AND OR DATA OBTAINED FROM
OTHERS. ' '
Unauthonzed alteration or addition to this document is a violation of Section 7209 SURVEY OF: �p'� Z�Q
of the New York State Education Lawes/
Certificationshisbehalf
toindicated hereon shallarun onlytothe personrmfor whom it is prepared ,' .\1 01 r/6/1`& A�
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and on his behalf to the Title Company,Governmental Agency and Lending L TT
Institution listed hereon,and to the assignees of the lending institutions or subse-
quent Copies ors MAlfir(n -) —1-5K/I4 �T
Copies of this document not bearing the professional's inked seal or embossed `I1III I 1 0
seal shall not be considered a valid true copy ' ` /
The offsets(or dimensions)shown hereon from structures to the property lines are l �E J� 1—�N 1�1 d-` ' v i,.sl i
for a specific purpose and use and therefore are not intended to guide the erection of t "v r� W 4 (�i�--
fences,retaining walls,pools,patios,planting areas,addition to buildings or any other
construction s
The existence of nght of ways and/or easements of record,if any,not shown are //
not guaranteed I!m OF ..►:VEY DATE: l I P SCALE:
CERTIFIED ONLY TO: . , `"2 ,DEi„79N C.GRA`-_4)._I DESTIN G. GRAF
L.-A/6.42-1-62 vii lED( frelcl, A1-s3A- a 0)6.-v( :N, __
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r , ,` : LAND SURVEYOR
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By �1 CE.''" #r y,' , 73 WOODLAWN ROAD
DESTIN G.GRAF N.Y.S. LIC No.50067 _ �_ , ROCKY POINT,NEW YORK 11778
TAX I.D. No. �000 - 1 Zo — O 3 — 8,Z S •4- ®:e a�,�0 , l PHONE(516)821-3442