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4 ; Town Hall, 53095 Main Road
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.`��®� ���;�' Southold, New York 11971
JUDITH T.TERRY --4.-.....„,../04�"�I FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1495-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ANTIGNANO, DENISE OR DOMINIC
Mailing Address 1 5745 ALVAHS LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 5745 ALVAHS LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5069
Tax Map No. section 101,.00 block 2 lot 15.000
Cross Street ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 7/11/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/4/45'
OFFICE OF THE TOWN CLERK
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Town of Southold Application No.
Judith T. Terry, Town Clerk • 4
Town Hall, 53095 Main Road x5, $10.00 - Residential /d BOO
p. O. Box 1179 w{ y` # i
04-crab
��� ��1�� � $25.00 - Non-Residential
Southold, New York 11971 '` ���`
Telephone 'Q( 4 `P
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
101
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ l®t
DATE 1/ - (9-0 —81
OWNER NAME: sent sx ay mini 1(4C Prrth' lel GL/'v]
OWNER MAILING ADDRESS: F645 1)-1
C:WNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 5/6, -- 7311 - 5 9
TAX MAP NO. : Section / BlockQ Lot 15
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential EV Non-Residential
DATE OF PREVIOUS PUMP-OUT: (,tom rjy.p wyt
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 App ant
RECEIVED BY:
Town Clerk's Office
DATE:
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Ni 0 i , VILLAGE OF GREENPORT
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>°y�—rte:-c�°ti°y . DOMINIC AND DENISE ANTIGNANO
Ngil� r' AT CUTCHOGUE
� �:„ �o . TOWN OF SOUTHOLD
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SUFFOLK COUNTY , N.Y.
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1000 - 101 - 02 - 015
a��,/ j N.Y.S. LIC. N0. 49668 n
. .. Prepared in accordance with the minimum SCALE I 60 '
standards for title surveys as established b NOV. 15 1985
CONIC S VEYORS & ENGINEERS , P. C. the L.rA.L.S. and approved ''and adopted 516 ) 76 5 5020 PP p //�.G'�- .
P. 0. BOX 909 - for such use by The New York State Land y 0
MAIN ROAD Title Association. .e/t�/ /fj•� 1 , l.� 0--44 (a ---4'"--D,c� e-�� 4 -�
SOUTHOLD, N:Y. II971 ( G /6,---
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