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JUDITH T.TERRY � � 4.03Town Hall, 53095 Main Road
TOWN CLERK ; #1=0 P.O. Box 1179
rrr � Southold,New York 11971
REGISTRAR OF VITAL STATISTICS : ® � � Fax (516) 765-1823
MARRIAGE OFFICER = �® ���� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER _ d 41
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. 3481-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner TRENKMANN, A. ESTATE, INC.
Mailing Address 1 187 LAFAYETTE ST
Mailing Address 2
City St Zip NEW YORK NY 10013-0000
Property Address 1 880 SOUTHVIEW DRIVE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 212-226-5284
Tax Map No. section 13.00 block 1 lot 11 .000
Cross Street BROWNS HILL ROAD
Issue Date: 6/25/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK '0FDU(
Town of Southold �O� ",.r° CQG Application No..3 / �d�
Judith T. Terry, Town Clerk t
Town Hall, 53095 Main Road 4 ,. . $10.00 - Residential
P. O. Box 1179 '• .4i �' $25.00 - Non-Residential
Southold, New York 11971 4 '
Telephone � ‘1\ •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ .
DATE CA/F6
OWNER NAME:
OWNER MAILING ADDRESS: /8 7 ��•- � S7&
zoo/2
OWNER PROPERTY ADDRESS: 575.0 Sw7 VPez•e.""
Qr-,^ 7� � 4? c - �. // 7 J 7
OWNER TELEPHONE NUMBER: ._f Z Z Z�-^Z,Y
TAX MAP NO. : Section a7--?.. Ud Block 44 00 Lot O//0 000
CROSS STREET: //44,-e_.•
TYPE OF SYSTEM:— Septic-Tank- .. ---.- -New Existing
'WO Cesspool New Existing
ResidentialNon-Residential
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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 o Applicant
RECEIVED,BY: -
Town Clerk's Office
____ ___ -
DATE: -. .. - - - - - -- •-
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