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JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK v m ` P.O. Box 1179
tt� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = V® �� Fax (516) 765-1823
MARRIAGE OFFICER ' ' ® �l� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER 7®1 ii
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. 3281-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner PESCI, ORESTE
Mailing Address 1 300 GEORGE ROAD
Mailing Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 300 GEORGE ROAD
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-7311-5029
Tax Map No. section 117.00 block 4 lot 17.000
Cross Street FRED STREET
Issue Date: 11/21/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE0.OF THE TOWN CLERK ciff 0/41(
Town of Southold �� CQ --_, Application No. c 0
Judith T. Terry, Town Clerk1; ,may •\I /
Town Hall, 53095 Main Road a ;z= , $10.00 - Residential r/
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P. O. Box 1179 : 3 a4+�
'�� ' `' $25.00 - Non-Residential
Southold, New York 11971 O0 �0���`
Telephone ( '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION lECe? Ve®
for NOV I7 sift
Sotristoici
OPERATION PERMIT Tows,agei
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE /I r ql
3 c/ / yd-/-,c-e-vmy4(6)
OWNER NAME: � I 6/e ES rC '
OWNER MAILING ADDRESS: ''. (2.(2) AriTh //'c
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OWNER PROPERTY ADDRESS: -Oc _0?-61.e �
OWNER TELEPHONE NUMBER: 7 3 41. S---(7) 2..
TAX MAP NO. : Section /17 Block Lot 1 7'
CROSS STREET: FI-€.i Ste'.
TYPE OF SYSTEM: Septic Tank 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.)
lOIZt,t- W CSD C
Signature of Applicant
RECEIVED BY:
own lerk's •ffice •
DATE: I , ) � , �
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