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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r71 Southold, New York 11971
Fax (5765-13
MARRIAGE OFFICER � Telephone1(5 6) 7651801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1698-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BROPHY, FRANK E. AND MARY L.
Mailing Address 1 P. O. BOX 217
Mailing Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 75 SECOND STREET
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-734-7318
Tax Map No. section 117.00 block 10 lot 20.007
Cross Street JACKSON AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 6/04/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c0FOUr
--
Town-of Southold % CQ - Application No. / 6 9
Judith T. Ter'y, Town Clerk ` - G
� � �G 7 $10.00 - Residential
Town Hall, 53095 Main Road a x= *�,_,
P. D. Box 1179 En , s .: .: i Z $25.00 - Non-Residential
Southold, New York 11971 p -ft - ��$
.(
Telephone Y.a0�► '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE May 29, 1991
OWNER NAME: Frank X.• &-Mary L. Brophy
OWNER MAILING ADDRESS: 75 Second St. - P.O. Box 217
New Suffolk, n 11956
OWNER PROPERTY ADDRESS: Same
OWNER TELEPHONE NUMBER: 516 734-7318
j TAX MAP NO. : Section 117 Block 10 Lot 20.7
CROSS STREET: Jaakenn St.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7/25/88
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.)
7,•-0,--pt.r i 4,_,--,A..../
Signature of Applicant
RECEIVED BY: / � 16- -1 c,
own Clerk's Office
DATE: /a ,( 5/
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`'` .''"=41'4-''''''SUFFOLK R�CO�INTY TAX MAP-n Er't- T-i. . Guarantees indicated hereon shell run - -. , . - . S '�'
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''a, ';,,,i, - :DIST,icto SECT, 117 BLOCK tG PA QT Or LOT 20? ,'> • is prepared.and on his behest to the - . �/'
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brie company,governmental agency end • '
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