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JUDITH T.TERRY ��_ �j Town Hall, 53095 Main Road
TOWN CLERK k y Z P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER ,\•• Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER .� -. ,,.' Telephone(516) 765-1800
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. 3406-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner FERRETTI, ROBERT
Mailing Address 1 P. O. BOX 1261
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1350 WOODCLIFF DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8001
Tax Map No. section 107.00 block 8 lot 1 .000
Cross Street GRAND AVENUE
Issue Date: 11/02/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
er
,OFFICE OF THE TOWN CLERK c31 F OUri;
Town of Southold Application Nex.906
Judith T. Terry, Town Clerk . *%.\
Town Hall, 53095 Main Road $10.00 - Residential
0.P Box 1179 C.13 e $25.00 - Non-Residential
,New Telephone
Y,ork .1).971
• • .- - -4,', ase0r,••!---- _ _
(516) 765-1
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION ,
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ib.00
, • .- DATE
•
• OWNER NAME: Zk f44/1(.44-;
OWNER MAILING ADDRESS:
Pti44zku.k Al it cc -
OWNER PROPERTY ADDRESS: 13C0 -
ism•41-:4-.1‹ ,t-ei it cc'L
OWNER TELEPHONE NUMBER: 1.c8- 1
TAX MAP NO. : Section 10-1 Block Lot 1
CROSS STREET: C4A.A.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool NeW Existing V
Residential N/ Non-Residential •
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
RECEIVED BY: ,1 *
• • . Town lierk's Office
" RECEIVED '
DATE:
OCT 3 0 1995 .
[own Clerk Southard