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F JI'DITH T.TERRY • y� Town Hall, 53095 Main Road
TOWN CLERK _ ; P.O. Box 1179
Southold New York 11971
REGISTRAR OF VITAL STATISTICS ViFax(516)765-1823
MARRIAGE OFFICER ‘‘'°;#11
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RECORDS MANAGEMENT OFFICER : 01 jig 1, ,d Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3452-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner AIELLO, FRANK
Mailing Address 1 445 EAST LEGION AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 445 EAST LEGION AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9184
Tax Map No. section 1143.00 • block 4 lot 1 .000
Cross Street BAY AVENUE
Issue Date: 3/27/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
II III
OFF-ICE OF THE TOWN CLERK S�FFD(,���'
Twn "of Southold , CQApplication No 7�a-
Jud2h T": Terry, Town Clerk ��, /
Town Hall, 53095 Main Road -< $10.00 - Residential L/
P. O. Box 1179 to ` $25.00 - Non-Residential
Southold, New York 11971
Telephone 70( * `i`a�to
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE J / v7 c
OWNER NAME: ra A n/ `1 4 ( f G L c
OWNER MAILING ADDRESS: Gf�f� F/4 5T / 0
l
OWNER PROPERTY ADDRESS: 3 /29
OWNER TELEPHONE NUMBER: —) C, ' (I' y
TAX MAP NO. : Section 1 Lk3 , Block Lot I
CROSS STREET: a,,` ,4'„ �� cQ
TYPE OF SYSTEM: , Septic, Tank New Existing
Cesspool New Existing 02--
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:
4
;I�, � /
town Clerk's Office -
DATE: /xz 1
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