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ELIZABETH A.NEVILLE l/,y Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
cos Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER � ®� '�� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER `
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3836-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner BERTOLINI, STELLA
Mailing Address 1 480 STERLING PLACE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 SAME
Property Address 2
City St Zip 00000-0000
Owner Telephone No. 516-477-0395
Tax Map No. section 34.00 block 3 lot 18.000
Cross Street KNAPP PLACE
...sr. is :�'�.
Issue Date: 12/21/98 Elizabeth A. e 'ille
Southold Town Clerk
•
(TOWN SEAL)
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OFFICE OF THE TOWN CLERKFOUrC"
TOWN OF SOUTHOLD • , c�® ®G Application No. 3�
, ELIZABETH A.NEVII.I.F,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 ����; $25.00 - Non-Residential
-- Telephone • �,� 41( ��®•
(516) 765-1801
RECOvirm
TOWN OF SOUTHOLD
DEC 6 1998
SOUTHOLD WASTEWATER DISPOSAL DISTRIC
�r ► = SowIthOia
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL Stella Bertolini
480 Sterling PI
Greenport NY 11944 !
Operation Permit No.
Fee $ •
DATE /Wit
OWNER NAME: '7 /Zi /` UP2--///$/ l 13Z—ERZ/, /
OWNER MAILING ADDRESS: 57 c5.-7---Z72---/--//1.62- ,/,i&-
//7//$z
OWNER PROPERTY AuurCt�a :
OWNER TELEPHONE NUMBER: JL' r77
TAX MAP NO. : Section 3 Block `---Z Lot
CROSS STREET: PP/9/6P it-4e -6:-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential X 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.)
/64(/ 411Pv .
Signature of Applicant
RECEIVED BY:
Pak--
Town Clerk's Office
DATE: )a C6 �'j�
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