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JUDITH T. TERRY z,Z < Town Hall, 53095 Main Road
TOWN P.O. Box 1179
CLERK
REGISTRAR OF VITAL STATISTICSs
MARRIAGE OFFICER ®_s Lin �� Southold, New York 11971
V •� Fax (516) 765-1823
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�1D® � Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2082-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DANOWSKI, EDWARD
Mailing Address 1 P. O. BOX 1118 -
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 875 FOX HOLLOW ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5230
Tax Map No. section 106.00 block 10 lot 27.000
Cross Street WEST MILL ROAD
. Date Of Last Pump Out 0/00/00
Issue Date: 3/22/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c�VFFO(,r''-
Town of Southold � C&G� Application Noc0f�:
Judith T. Terry, Town Clerk . �a� :
Town Hall, 53095 Main Road " "'K -� $10.00 - Residential
P. O. Box 1179 P:-.• • $25.00 - Non-Residential
Southold, New York 11971 O ®_ _ �•`�
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. -
Fee $ /.0
DATE "/7 -9'3
OWNER NAME: E-dWOJ'01 �( n 0 t/JSKA
OWNER MAILING DDRESS:P' 0 • I Ox j -13
8'`75 `' UThO`fi 'I cf'11,1_PJL, )J. . E'[q5.
,OWNER PROPERTY ADDRESS: ep`-f'c-, 14-MOO /Cct
eco-J- -ro ,fc. -
OWNER TELEPHONE NUMBER: IG- 2,q1?' 3o
TAX MAP NO. : Section Block Lot
. CROSS STREET:
TYPE OF SYSTEM:• Septic Tank New Existing
•
`` Cesspool ' ' New Existing
Residential Non-Residential -
DATE OF PREVIOUS PUMP-OUT:
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.)
___,--iptheor ,.,f_At906/
Signature of Applicant
RECEIVED BY: -
Town Clerk's Office
DATE: _
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JUDITH T. TERRY "' ;;, u = "''` Town Hall, 53095 Main Road
TOWN CLERK j =sc ' a `==i? P.O. Box 1179
` ` r Southold New York 11971
REGISTRAR OF VITAL STATISTICS Z i "1` ' 1^ '
<_,^r " "' Fax (516) 765-1823
' MARRIAGE OFFICER c, , �r.: „y,>
Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
• June 10, ' 1992
Edward Danowski -
400 Deer Path
Mattituck, New York 11952
Re: 106-10-27 5-92
Dear 'Mr. Danowski:
Our records indicate that you recently had your cesspool/septic tank system
pumped out. According to the Southold Town Scavenger Wastes Ordinance,
any owner of an operating, on-site sewage disposal system, such as a septic
tank or cesspool, must obtain an Operation Permit for that system.
The Operation Permit is issued by the Southold Town Clerk's Office. The
fee is ten dollars ($10.00) for a residential system, twenty-five dollars ($25.00)
for a non-residential system. You will not be asked to obtain an Operation
Permit each time you have work done on the system. , The permit is only issued
. once for each system.
Enclosed is an application for an Operation Permit. Please complete the
application and return it to this office along with the location map and proper
fee. (NOTE: The location map may be a copy of your survey with the location
of the cesspool(s) indicated or a sketch of your property showing the location
of the buildings, cesspool system, and approximate distance in feet to buildings
and closest road.) Also included is an Informational Bulletin regarding the
Southold Town Scavenger Waste Treatment Facility. I hope this will aid you
in understanding the Scavenger Wastes Ordinance.
Please do not ignore this request. Should you have any questions or need
any assistance with the application, please do not hesitate to contact this office.
We will be happy to- assist you in any way we possibly can.
Very truly yours,
•
•
Judith T. Terry
Southold Town Clerk
Enclosures (2) '
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