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JUDITH T.TERRY 11 _. er, Town Hall,53095 Main Road
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TOWN CLERK P.O.Box 1179
1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER • Fax(516)765-1823
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RECORDS MANAGEMENT OFFICER ®l ��„, Telephone(516)765-1800
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. 3409-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner BARBARO, JOSEPH R.
Mailing Address 1 51 CASTELTON COURT
Mailing Address 2
City St Zip OCEANSIDE NY 11572-0000
Property Address 1 1675 SICSBEE ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-764-6644
Tax Map No. section 144.00 block 2 lot 12.000
Cross Street ROUTE 25
Issue Date: 11/24/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFir,E OF THE TOWN CLERK ,c3IFD(,���'
Town of Southold Application No. 3(
Judith T. Terry, Town Clerk :� /
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Town Hall, 53095 Main Road a „ ' • • �, $10.00 - Residential (0 '
P. 0. Box 1179 >=t`•; • $25.00 - Non-Residential
Southold, New York 11971
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Telephone : ,( q
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. p-11 .11-- -))31i(
Fee $ ID "r
DATE
OWNER NAME: ®/OSCP 3,4/�/3.40
OWNER MAILING ADDRESS: 6/ (psi// ,v
e4-,0cS it‘y //5��
OWNER PROPERTY ADDRESS: /675" So,.slee_
41--`Tri rya- //%1L
OWNER TELEPHONE NUMBER: PPC 76g fit/
3c(i9 iW •-Z -l ---
TAX MAP NO. : Section / !y(!/L Block � Lot
CROSS STREET: Rr
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.)
(Ce,c__ 4/41-)
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Signatu v Applicant
RECEIVED BY: ` 6
Town ' erk's Office
DATE: •
PLECEIVED
NOV 61995.
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