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v' � Town Hall, 53095 Main Road
0 �1 P.O. Box 1179 .
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y�Q( ifi `��®i�� Southold, New York 11971
JUDITH T. TERRY �%,...... ,/A4I, 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. 1081-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SPINELLO, ANTHONY
Mailing Address 1 3 WASHINGTON SQUARE VILLAGE
Mailing Address 2
City St Zip NEW YORK NY 10012-0000
Property Address 1 YOUNGS ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 212-777-6628
Tax Map No. section 18.00 block 2 lot 37.004
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 4/13/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF -9-1E TOWN CLERK ��M�
Town of Southold ��� CQ� Application No./011
Judith T. Terry, Town Clerk �` "' ' s G
-' `� 1 Residential
Town Hall, 53095 Main Road aze. .
P. O. Box 1179 crs -? ;' Non-Residential
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Southold, New York 11971 OS-4,‘"ge
���Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE Li/ / / fir
OWNER NAME: 110 561 1n./L
OWNER MAILING ADDRESS: 3 " (.) ciA- -fg1,61-e.. i/cje
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OWNER PROPERTY ADDRESS: o- if B`°a-4
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OWNER TELEPHONE NUMBER: --P-- '11'9 - 6-C
TAX MAP NO. : Section I U Block 2- Lot 3/17, Y
CROSS STREET: 1OAV5 y oCr d PI cc ?it°
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing 7
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: gl 9 /8S
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.)
Sign tune . Applicant
11
RECEIVED BY: - �J
Townerk's ffice
• DATE:
APR 13 1989
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