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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® •
rri P.O. Box 1179
tl' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS VO �•� Fax (516) 765-1823
MARRIAGE OFFICER �' ® .t Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER eet t'
FREEDOM OF INFORMATION OFFICER ii<����
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3223-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SANTAN I ELLO, PASQUALE
Mailing Address 1 1085 WIGGINS LANE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 1085 WIGGINS LANE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-2689
Tax Map No. section 35.00 block 5 lot 9.000
Cross Street DAWN DRIVE
Issue Date: 7/13/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OFTHE TOWN CLERK I
•c�vFFOGr''-
Town of`Southold �
ea-- Application No.3(32'°23
Judith T.' Terry, Town Clerk � wa
Town Hall, 53095 Main Road ;'„ C 1 $10.00 - Residential
P. O. Box 1179 An, �; $25.00 - Non-Residential
Southold, New York 11971 O . ®:T''x" �`
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Telephone )0-0°.= .( `
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE ‘A
OWNER NAME: PIIf uttk,
OWNER MAILING ADDRESS: (O g W), . S I
rEei par- - �ei-4
ty JV- P• 1 / _-•_
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 5 i 6 d 411 - A.(o e??
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TAX MAP NO. : Section 3Block Lot I
CROSS STREET: )-ton
TYPE OF SYSTEM: Septic Tank u/ New Existing P/
Cesspool New - Existing
Residential 1/-
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: ,y__
Clerk's Office
DATE: JUL ' 1994
town Clerk Soulhote
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