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Town Hall 53095 Main Road
ELIZABETHA.NEVILLE � -134: '
TOWN CLERK ® P.O.Box 1179
E Southold,New York 11971
REGISTRAR OF VITAL STATISTICS :ft; y /�� Fax(516) 765-1823
MARRIAGE OFFICER / Tele hone(516) 765-1800
RECORDS MANAGEMENT OFFICER 42/ * P
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. 3794-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner GALATI, WILLIAM AND DOROTHY
Mailing Address 1 P. O. BOX 1264
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0935
Property Address 1 575 WATERSEDGE WAY
Property Address 2
City St Zip SOUTHOLD NY 11971-0935
Owner Telephone No. 516-765-3279
Tax Map No. section 88.00 block 5 lot 61 .002
Cross Street LONGVIEW LANE
Issue Date: 6/16/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �
SH _ 3 77 V
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TOWN OF SOUTHOLD 0�, c . Application No.
ELIZABETH A.NEVIJ.1 F,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOOTHOLD,NEW YORK 11971 $25.00 - Non-Residential
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Telephone ei jig .0 ,�'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL •
Operation Permit No.
Fee $( '
DATE f/./3/7-S
OWNER NAME: \/0//4 c3F 1,Orq0
OWNER MAILING ADDRESS: a°,(9, 4 ' ' // ''lac
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OWNER
PROPERTY ADDRESS:
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OWNER TELEPHONE NUMBER: 2 2--,7
TAX MAP NO. : Section OTr®® _ Block O coo Lot 06/ Cog
CROSS STREET: L el/7.
TYPE OF SYSTEM: Septic Tank New Existing l/
Cesspool t 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.)
24;
Signature of . . ican
RECEIVED BY:
Town Clerk's Office
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DATE:
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