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OFFICE OF THE TOWN CLERK cOFOLAF ,'
Town of Southold Ol/
Judith T. Terry, Town Clerk �` y 4
Town Hall, 53095 Main Road ~
P. O. Box 1179cna_r`
Southold, New York 11971 Oft 6Og•'�
Telephone �l s [ „,-
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
• CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 97 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
PERMIT ISSUED TO:
NAME: Anthony Imbriano
ADDRESS: 136 Cleveland Drive
Massapequa, New York 11758
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY-: Anthony Imbriano
OWNER MAILING -ADDRESS: 136 Cleveland Drive
Massapequa, New York 11758
OWNER PROPERTY ADDRESS: 32245 Main Road
Cutchogue, New York
TAX MAP NO. : Section 97 Block 5 Lot 6
CROSS STREET: Cox Lane
BUILDING PERMIT NUMBER CROSS REFERENCE: Pending
a r( 4;7 r. 415
Judith T. Ter,r�1�
Southold Town Clerk
DATE: January 21 , 1987
t
(TOWN SEAL)
c,§SVFU
gik Alf4 ''�''° ; ; Town Hall, 53095 Main Road
,�'' ,, r�, � P.O. Box 1179
1
Q� �° ���� Southold, New York 11971
JUDITH T TERRY ����u�et"/ TELEPHONE
TOWN CLFRI. (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
January 21 , 1987
Anthony Imbriano
136 Cleveland Drive -
Massapequa, New York 11758
Re: 32245 Main Road
Cutchogue, New York "
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic'Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior -to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10. 00) for
residential use and twenty-five dollars ($25.00) for non-residential.
Please have- the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
For your, general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly ?tours,
Judith T. Terry
Southold Town Clerk
Enclosures (3)
JTT/Ijc
•,•�///n r��
`6% a s cpb
ti V Town Hall 53095 Main Road
P.O. Box 728
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* 1% i° Southold, New York 11971
�.,..,I .
JUDITH T TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
December 30, 1986
To: Victor Lessard, Southold Town Building Department -
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 96 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Anthony Imbriano
Please review the application and location map and advise if the
project has received Suffolk County Health Department approval
and if we may issue the permit.
Please complete the form below and return it to my office.
Thank you.
•
1.01per Node
Judith T. Terry
Southold Town Clerk
I have reviewed the application and location map of the project
cited above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS:
Signature
Date
i1
OFFICE OF THE TOWN CLERK
Town of Southoldp
Judith T. Terry, Town Clerk Application No. r
Town Hall, 53095 Main Road Construction
P. 0. Box 1179
Southold, New York 11971 Alteration
Telephone Residential V
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. I
Fee $ fb,UO
DATE fa' q
APPLICANT NAME: a/
APPLICANT ADDRESS: 1 , .
SEPTIC CESSPOOL 1Z
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION •77243
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTRATION:
OWNER OF PROPERTY: 0/yjal ` ,Q,k_ftLefr,_,a
OWNER MAILING ADDRESS: J 3 f0 09,,j, -,,,j. p► •
OWNER PROPERTY ADDRESS: y S ')1,r - ((R69--
TELEPHONE NUMBER OF CONTACT PERSON: 7q,s-5cl3 f
TAX MAP NO. : Section rj' 7 Block s Lot (P
CROSS STREET: (--) Cc
BUILDING PERMIT NUMBER CROSS REFERENCE:
a1'9 Let-
'Signature
of Applicant
RECEIVED BY: 4 , /'
•wn , I'rk'. Office
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