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JUDITH T. TERRY : ;yam Town Hall, 53095 Main Road
TOWN CLERK
` P.O. Box 1179
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• Southold, New York 11971
REGISTRAR OF VITAL STATISTICSWol
MARRIAGE OFFICER 4 =4 " V'..+ Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER -_ p. Telephone (516) 765-1801
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. 3244-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner SERRANO, LUIS AND SHARYN
Mailing Address 1 22 MARLIN ROAD
Mailing Address 2
City St Zip CENTEREACH NY 11720-0000
Property Address 1 160 ALVAHS LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-698-2787
Tax Map No. section 109.00 block 2 lot 5.000
Cross Street MAIN ROAD
Issue Date: 8/29/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
IIS
OICE OF THE TOWN CLERK '
FFc�vFFO(,-�
Town of Southold �� CQ � Application No. J a C44(
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road a _; ;, .•G I $10.00 - Residential
1 'r'I
P. O. Box 1179 u' t ' � $25.00 - Non-Residential
Southold, New York 11971 O "•®,
Telephone! . t "
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
• APPLICA T l t
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: Luis and Sharyn Serrano
OWNER MAILING ADDRESS: 22 Marlin Road, Centereach, New York 11720
4 W NEI PROPERTY :-.e^DnES'S : 160 Aivahs Lane - -- --
Cutchogue, New York
OWNER TELEPHONE NUMBER: 698-2787
•
1 1
TAX MAP NO. : Section 109 Block 02 Lot 05
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank x -New x Existing
Cesspool x New x Existing
Residential x Non-Residential
1 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.)
VER DE HOMES, INC.
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Si ture of A. .lic t
izabeA. Cannaza •, �o. owner
RECEIVED BY: 44«o._ 049-070,1-4-)
mama, Cerk's Office
DATE: AUG 2 9 1994
Town Clerk Southold
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
FOR APPROVAL OF CONSTRUCTION ONLY -
93 SO 94 The water supply and sewage disposal Prepared in accordance with the minimum *1-TN.Y.S. LIC. NO. 49618
DATE HS.REF. NO. systems for this residence will conform slondords /or title surveys as established
to the standards of The Suffolk County s/s/ya hse sfr,.�t ` by the L./,A.L.S and approved and adopted PECONIC SURVEYORS, P.C.` -
Department of Health Services. 07/94 well aac�d for such use by The New York State Land (5161 765-- 5020
Title Association. P. O. BOX 909
APPROVED MAIN ROAD
ELEVATIONS ARE REFERENCED TO AN ASSUMED DATUM. SOUTHOLD, N.Y. 11971
93 —288