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JUDITH T. TERRY • Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘V.. Fax (516) 765-1823
MARRIAGE OFFICER - 4$
4$ Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER : ®1 0
FREEDOM OF INFORMATION OFFICER �1,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3202-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MARANGAS, THEODORE
Mailing Address 1 P. O. BOX 155
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1600 WESTVIEW DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8653
Tax Map No. section 107.00 block 7 lot 18.000
Cross Street BROWER ROAD
Issue Date: 5/19/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK .c��FFI(A- •
Towyn of Southold �� ter' CQG Application NoO
Judith T: Terry, Town Clerk
Tows—rHall, 53095 Main Road cn V $10.00 - Residential
P. O. Box 1179 r z X ,a �� $25.00 - Non-Residential
Southold, New York 11971 O ®. ± ' ' z
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Telephone oj Y► I
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /19•f
DATE // "ri'>
"RANOWNER NAME: ��fO 71)0a71)0a .,4�OWNER MAILING ADDRESS: i � %O, /cs-
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OWNER PROPERTY ADDRESS: /i190 114S fPlfP / ,C.JP)fr
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OWNER TELEPHONE NUMBER: 02942.'
TAX MAP NO. : Section 1Q 7 Block 7 Lot /7
CROSS STREET: /Raw, efe.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
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 Applic ht
RECEIVED BY: C ^
"Town Clerk's Office -
DATE: �� / /( 1
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