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JUDITH T. TERRY f► Town Hall, 53095 Main Road
TOWN CLERK O P.O.Mt • Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER O O�
' Fax (516) 765-1823
1P,1 o� Telephone (516) 765-1801
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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. 3184-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner TRAPANI, BENEDICT
Mailing Address 1 50 SECOND STREET
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 50 SECOND STREET
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-8240
Tax Map No. section 126.00 block 7 lot 15.000
Cross Street BRAY AVENUE
Issue Date: 3/16/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'c)\\VFU� _ . ����
Town of Southold �� _,. L'G Application No.
Judith T. Terry, Town Clerk
3 I
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 u' _ �r 'moi z $25.00 - Non-Residential
Southold, New York 11971 O •� •�`
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Telephone _ .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLE, AT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •I O '
DATE 244
OWNER NAME:
OWNER MAILING ADDRESS: 50 a2 " Sr,
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OWNER PROPERTY ADDRESS: /l •
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OWNER TELEPHONE NUMBER: 574 94)- F XV'e
TAX MAP NO.. : Section O. && Block 7 Lot / 5—
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,ik CROSS STREET: Ag/-}y
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
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 Appli, ant
RECEIVED BY: • • fO , .
REC C1e'k's Office
DATE: MAR 1 5 1994
ilown Clerk Southof
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