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Town Hall, 53095 Main Road
1. axzsa}�' � P.O. Box 1179
� 14V�/ Southold, New York 11971
JUDITH T.TERRY - TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 938-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SPANO, LEONARD F.
Mailing Address 1 SPANO, AVE MARIA
Mailing Address 2 505 BAYER ROAD
City St Zip MATTITUCK NY 11952-0000
Property Address 1 505 BAYER ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5819
Tax Map No. section 139.00 block 3 lot 13.000
Cross Street GRAND AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 11/30/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'c�vFFULA- 3
Town of Southold t� CQG'_, Application No.
Judith T. Terry, Town Clerk . .A 4.4, .1-4
Town Hall, 53095 Main Road L'' sr sa "� Residential
n
P. O. Box 1179 cn �« . ; Non-Residential
Southold, New York 11971 O ®� 1• '.:l �/J
Telephone _Q( ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /.0-°-6 •
DATE Ala. 071. Mf
OWNER NAME: 6.,eariCLrd F Spero Ove ma•r/w 406.174
OWNER MAILING ADDRESS: ,32)L5- ,er i&/
A tti/a,ch /V/ /i' -;
OWNER PROPERTY ADDRESS: (1 (1_•177 , 6{,6 4.4,60Vel
OWNER TELEPHONE NUMBER: 6/4 cp9/ 5'/9
TAX MAP NO. : Section /39 Block � Lot /3
CROSS STREET: 6ra,1)61 age-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool q/ New Existing I/
Residential / Non-Residential
DATE OF PREVIOUS PUMP-OUT: 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.)
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Signature of pplicant
RECEIVED BY: r _p, c •
Town Clerk's ffice
DATE:
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`If. — -- V , , - UNAUTHORIZED ALTERATION OR ADDITIOIG>
, porch��, TO THIS SURVEY IS A VIOLATION OF
' C4:1 C SECTION
EDUCATIONO9 UWF THE NEW YORK STATE
1 e0 ail j '1 kr) �� ^ COPIES OF THIS SURVEY MAP NOT BEARING
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—r MON. . Ju Ci r '�J�r W /op. Q r •� ONLY TO THE PEFSON FOR WHOM THE SURVEY
-- IS PREPARED, AND ON HIS B.:HALF TO THE
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_ - _ - - TITLE COMPANY, GOVERNMENTAL AGENCY AN
'` , �--` - - - LENDING INSTTUTION LISTED HEREON, AND
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'? /'7 YG t C R G' TUTION. GUARANTECS ASE NOT TRANSFERABLE
Y, TO ADDITIONAL INSTITUTIONS OR SUBSEQU8
/ / OWNERS, /
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