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JUDITH T.TERRY ����� � Town Hall, 53095 Main Road
TOWN CLERK ® ; P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `�® a "; Fax(516) 765-1823
MARRIAGE OFFICER \"4
RECORDS MANAGEMENT OFFICER i ®.( �► ��i 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. 3444-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner FINGERLE, MICHAEL AND CHERIE
Mailing Address 1 P. O. BOX 1615
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 770 CHABLIS PATH
Property Address 2
City St Zip SOUTHODL NY 11971-0000
Owner Telephone No. 516-765-4947
Tax Map No. section 51 .00 block 3 lot 3.001
Cross Street BURGUNDY COURT
Issue Date: 3/07/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
ISI
OFFICE OF THE TOWN CLERK �FF(
Town of Southold ��� CQGt,\ Application No. �V(K
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179cn , ,i
$25.00 - Non-Residential
Southold, New York 11971 OO1 09"/
J,
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. VS (J R
Fee $ � , ®°
DATE 3 - q-' q.6
OWNER NAME: jV ) 2JIIOt( 1" l /J�d'E� r ivI jeyIe_
OWNER MAILING ADDRESS: PO 15c /615
SDU J4 Dlr1 , A) liql(
-OWNER PROPERTY ADDRESS: 770 air abi 15 PaTh
OWNER TELEPHONE NUMBER: /6 ``C`"IgI--7
TAX MAP NO. : Section 51 , Block 3 Lot .5i 00 f
CROSS STREET: 6(,.t" �,((0, c( 0oLL�
TYPE OF SYSTEM: Septic Tankrr' New >< Existing
Cesspool New )( Existing
Residential 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.)
SignatVVViamf-07Hitc.(1.--A4--/
lApplicant
RECEIVED BY:
kralarnes Office
DATE: MAR 7 1996
Town Clerk Southold
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760--4/9417
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I am familar with the Standards for
Approval and Construction of Subsurface
..
,,....,"
Sewage Disposal Systems for Single Family
Residences and will abide by the conditions
set forth therein and on the permit to
construct.
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