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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® ' •
ac P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS t %® Fax (516) 765-1823
MARRIAGE OFFICER ':�� a�®I�� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ®,l 1�
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3225-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner QUINTIERI, EDWARD, JR.
Mailing Address 1 P. O. BOX 281
Mailing Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 1577 NEW SUFFOLK AVENUE
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-734-5334
Tax Map No. section 117.00 block 6 lot 22.000
Cross Street BUNNY LANE
Issue Date: 7/21/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• •ice
OFF! OF THE TOWN CLERK aa6--
Town of Southold �Oe4,7-% Application No.
3udith T. Terry, Town Clerk 0`' r`
Town Hall, 53095 Main Road r 7 $10.00 - Residential
P. O. Box 1179 cryt""'
� � � $25.00 - Non-Residential
Southold, New York 11971 O t
Telephone : .i `
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ I �
DATE 11I
OWNER NAME: Lt3�In � d E !
OWNER MAILING ADDRESS:„. O. c j zi
OWNER PROPERTY ADDRESS: \ '-1-1 '�j i ��( � CAkia
OWNER TELEPHONE NUMBER: 1-M4-
TAX MAP NO. : Section 1/7 Block Lot piQ
CROSS STREET: U,A0,--
( V_CtlYe
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.)
J:21ZA
,2A---kilj ))./'
Signature Applicant
RECEIVED BY: X.. ' ' - I -
t;T-v;.:` '-:l -rk's Office
DATE: JUL 1 9 19%
Iowa Clerk Southofit
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