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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK +; bagP.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS t Fax (516) 765-1823
MARRIAGE OFFICER _® ��® �' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER
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. 146-N Residential Non-Residential X
Fee $ 25.00 New Existing X
Name Of Owner AMMIRATI, DIANE AND FRANK
Mailing Address 1 P. O. BOX 288
Mailing Address 2
City St Zip MATTITUCK NY 11952-0288
Property Address 1 730 LOVE LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5299
Tax Map No. section 140.00 block 2 lot 18.000
Cross Street ROUTE 48/PIKE STREET
Issue Date: 5/26/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK oc��FF°(�, �f ,//
` Town of Southold =<�� 4 `,� .s C'� Application No. /710
Judith T. Terry, Town Clerk -- l *_ ' .
Town Hall, 53095 Main Road ` '```` .t I $10.00 - Residential
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P. O. Box 1179 tr3 ,�ii.�«� s` y���` $25.00 - Non-Residential
Southold, New York 11971 O ® .> x.- �`
Telephone .( '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. itly/
Fee $
DATE
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OWNER NAME: /6giYi® £ 7-1e6411)-(?. (OM IR/i- I
OWNER MAILING ADDRESS: ( le 0 Bo --fe ,
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OWNER PROPERTY ADDRESS: _00-1 I ,'' //
M/'-T77 ill". ... / /0.x`15 .
OWNER TELEPHONE NUMBER: /6 — %/'e5 f f ,
TAX MAP NO. : Section /40 Block Lot ifg,, 00
CROSS STREET: --kr — 46 C 6< � .c ,
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TYPE OF SYSTEM: Septic Tank ew ? fisting
Cesspool New V Existin9
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Residential Non-Residential /„...7
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.)
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Si: re of Applicant
RECEIVED BY:
Town Clerk's Office
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DATE:
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