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JUDITH T.TERRYyet; Town Hall, 53095 Main Road
TOWN CLERK • Z , P.O. Box 1179
w Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER y� ���1� Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER ®1 �a,,.� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ssig
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3392-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MULE, FELIX AND DIANA
Mailing Address 1 1295 SIGSBEE ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1295 SIGSBEE ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9564
Tax Map No. section 144.00 block 2 lot 5.000
Cross Street ROUTE 25
Issue Date: 10/12/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c�UFF�(x��= 33?
Town of Southold �QG=\ Application No.
Judith T. Terry, Town Clerk �� .- k �' y
Town Hall, 53095 Main Road -< $10.00 - Residential r/
P. O. Box 1179 cn °° n ' $25.00 - Non-Residential
Southold, New York 11971 ��`�
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Telephone
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
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DATE C-7 7 r
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OWNER NAME: . Y) V L I / 4 14),v
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OWNER MAILING ADDRESS: / )ZgS J / J+e� 74 �.17
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OWNER PROPERTY ADDRESS: £ sem- 4r A ,:) k .
OWNER TELEPHONE NUMBER: ).--67 &) -CC "
TAX MAP NO. : Section / 09- Block 0 Lot
CROSS STREET: /<`�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing ✓r
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.)
Signature of Applicant
RECEIVED BY:
• Town Clerk's Office
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DATE:
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