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Mannino
JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERK • P.O. Box 1179 REGISTRAR OF VITAL STATISTICS CPQ , Southold, New York 11971 MARRIAGE OFFICER , Fax (516) 765-1823 ® 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. 1808-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner MANN I NO, SANTO & JOAN Mailing Address 1 BOX 1409 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 420 CEDAR DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-5040 Tax Map No. section 78.00 block 9 lot 8.000 Cross Street CEDAR LANE & SUMMIT ROAD Date Of Last Pump Out 0/00/00 Issue Date: 11/20/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK �FFO �5, Town of Southold 0� : C'QG'; Application No. rag Judith T. Terry, Town Clerk ,4 ;;fir'; .ikr :'=y Town Hall, 53095 Main Road -4. 1 $10.00 - Residential /O, • P. O. Box 1179 UJ' ! �` $25.00 - Non-Residential Southold, New York 11971 O 0��t`� Telephone Q( *6 1•4 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT • APPLI CATION for `' OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee -$ - • . _ • 0 DATE , OWNER NAME: gacr2-7--o ®C--n Ma-34 JP)ri) 0 OWNER MAILING ADDRESS: /.,,(5 <Cepa (27-x: . ./..)/.,,(50X /9c9 <T©vT,�04) //971 OWNER PROPERTY ADDRESS: - G�€2 �.DQ.R g S/9 2--A 0/p7//9 7l OWNERcTELEPHONE NUMBER: 7.,g` ®/� • . � 0 39 TAX MAP NO. : Section Block Lot 0,4`5/ C Teezcce CROSS STREET: C4P/4 X 2&,ip (14-• 50-147il, ; T 71), TYPE OF SYSTEM: Septic Tank New Existing *-- Cesspool X New Existing X Residential x Non-Residential DATE OF PREVIOUS PUMP-OUT: (2// Jf/bk(-) J LOCATION MAP: Must be attached hereto before permit maybe issued. , (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) OSignaclee.---/----774..-i-of--,-,-',"ofApplicant RECEIVED BY: Town Clerk's Office DATE: i_---------- - -----•- '_ _. . . - - OF NEN✓ J... a e} I 7c: FK Vq ,o�Q s Q� • ,, ^t�is•r V'bfafl0n of 'r' t NI ,',,..'11 of the P3ev fork St=,tri LU i cc -!�t x aavcn law. • I ' rr, «of tht:s'irvnv map not baarii,t i 7 k, . ,:,;}a,,t Seruayor s inked seat o; 1 '� C S 25h %i" ,n� nt:seat shall not f e conslder�d Q FFpC 6 /iy OF Pe OF ry ;n be a valid true,ropy Guarantees indicated hereon shell ti,i. .W sl�f�{/�Yf�' �� only to the person for whom the survci �( 41 it t euared,and on his behalf to the N. �'_+ _ 7r 1/ i'• tele company,governmental agency end i CTh ' { ( �{ R ��� ! r f -\(( 9 l.r,:ing institution listed hereon arc 1 c,) • s...._-'(--•¢( `,(` N,-- r �' , _!'4.�1�� ~`I` ,k' ! ' t o the,assignees of the lenang instil. .5' 64'x;4'_50"E• — 4-4;_'•O.n `i 1... -----_--- —- .0 ion Guarantees are not trensferahte Q" • —^— "' =s 7 er sdd'ionel institutions or subsa9u§nt �,� , a ;: ': �'` - i.•, f 9 / 0 d .,/ ti blo:i:(t(� 0f,OW'1rAl,f�F 5Q,U"7"F�OLo,/V-Y ' • . I ^� Jf,"/, 1~f I, i f `mac j = fi D Loy ). 'V,y roa;c J t._�__.I Q 1 \ (• I L4 rcr'-zi q 1 s. 7 ik i .c, f w ,lt " I.�' I I ;� p blacka� •31-i tri ^ra r. ...1 ' �. a �-A(ci.r••a� 1 1 _ _- # i ,.. levatic�r�s',.�s> bwtrcJt'�' r�f��iv+� lire ' {' 1 : B: ' I It n uHy c/_ %!vaf,oti e f_40 c 1 fes ?` have � }:_..�• _ - 'a leve/ .-�rrf?': ti 'o f :3`;o f Pd�� ''�V It/ �'S�1'30"tN - /ZO.tJ '' C,e,./ar Lar`f4,f�iY 1,;:5`ut tlrmi,f'l "t�a</ --L-., •_ , ' i i. .;.',ill 1,04' 6I Wt?11.5-&HY,e•e�5 p 0 i� -�• .` sti�ir/rt. p vvf fkfry i t?,,af lfr,Pv .t , 4#1:11?* i I 0, 0 i , 1:P.1:::'. .rr, �" ► �C..o0-47 foi- 6;� ai•/ 5 U„ AI Al 1 /` ''r' ^'Jul' c�Y, ! a ►?'.• rr 1 I a l-rj t-t-'lfi...e J ,•4c:'71-11&L1. ' n. h.-t:iC u�t irt: Corp. Area:12,Cx?Qsq .• j t',,:'.< ' a,ic! {z�' t.,d3c:5��7iar5�c'I `—= vf�tc�� rte /Vale Gm ria ere sdaotw/t i' - ScRira 4CYL7: tri „ ". .� 7�Y ,} tai' �t� 5UYt✓ Cf. :ii:,;..-ii /l� 1 �� f 7145:11de . fd=.a,s tik / Ul+4, i CteI'k's •i',43.,;;;:,-,:•-7,,',;:;-;',,•4•:,::',•:4,''. . -, �: I `!Y c ; / - \\ ; .._..._._._.