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ELIZABETH A.NEVILLE �it° �; Town Hall, 53095 Main Road
TOWN CLERK i ® P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �� Fax(516) 765-1823
MARRIAGE OFFICER \-:**
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RECORDS MANAGEMENT OFFICER � eft "_�-_ 4.�®ii��� 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. 3786-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner FIORVANTE, ANTHONY AND KAREN
Mailing Address 1 765 CEDARFIELDS DRIVE
Mailing Address 2
City St Zip CREENPORT NY 11944-0000
Property Address 1 765 CEDARFIELDS DRIVE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-3037
Tax Map No. section 40.00 block 5 lot 1 .019
Cross Street MOORES LANE
Issue Date: 4/30/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �FFO - 8'
46
TOWN C4 SOUTHOLD
CLERK _
Application No. J
BLIZABETHA.NEVILLE,TOWN CLERK 10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 *.$ 0 - Non-Residential
• Telephone 01
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ? )
DATE AF'1Z11._ /F93
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OWNER NAME: A. 4TUoJd/ d . { WARE N
OWNER MAILING ADDRESS: 7( / :7s 111`/a
G 12 149?2tZ`1—
OWNER PROPERTY ADDRESS: (0•;-Mg)
OWNER TELEPHONE NUMBER: 477-moi �7
TAX MAP NO. : Section i/O- Block 5 Lot e,
CROSS STREET: aC21'G! LA4J
TYPE OF SYSTEM: Septic,Tank Existing " 1✓
Cesspool V 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.)
Signatp're -of Applicant
i
RECEIVED BY:
Town Clerk's Office
DATE: SK(S.T
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