HomeMy WebLinkAboutDebowski rgUr
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Town Hall, 53095 Main Road
` % P.O. Box 1179
=_ ® �� ��1Southold, New York 11971
JUDITH T.TERRY =.__`� ,i!�� TELEPHONE
TOWN CLERK �!4��////� (516)755-1801
REGISTRAR 01-VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 881-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DEBOWSK I, SOPH I E
Mailing Address 1 SCHOOL HOUSE ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 SCHOOL HOUSE ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
, Owner Telephone No. 516-734-5364
Tax Map No. section 102.00 block 5 lot 13.000
Cross Street DEPOT LANE
Date Of Last Pump Out 0/00/00
Issue Date: 10/12/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK QC.31FO C'
-
Town of Southold .>> . OG Application No. Ek/
Judith T. Terry, Town Clerk 0.
Town Hall, 53095 Main Road ^ � :'� Residential
P. 0. Box 1179 �' '` ` i
� � � ��. � Non-Residential
Southold, New York 11971 O J'
Telephone 4' M� ��
(516) 765-1801
TOWN OF SOUTHOLD
061 03 MS SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ JO.0o
DATE 1i/ff
OWNER NAME: ��j� - . b,6/1F)1Os'fr
OWNER MAILING ADDRESS: wool i._ a
,146,04 ,449,. /
OWNER PROPERTY ADDRESS: . 0_41.06/ /1..4_
(AA",
OWNER TELEPHONE NUMBER: 7..(/_ y
TAX MAP NO. : Section /W.. Block ,5 Lot
CROSS STREET: perct444,7.4-
TYPE
i7.4-TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing y
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.)
t, -" r
"-/
Signa ure o pp icant
RECEIVED BY: -� , _
RECE
riplawn Crerk' Office
DATE: O f' lcipq
Town Clerk Southold'
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,•;1'.41,,€�3 ,', ` Town Hall, 53095 Main Road
4:3-Y, ``: , ; _ "° I' P.O. Box 1179
`''�" fZ �' r Southold, New York 11971
- ``meq Ya
JUDITH T.TERRY QUA «k 4 TELEPHONE
s
TOWN CLERK Aril/i/ (516) 765-1801 ``
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK ..
TOWN OF SOUTHOLD
•
September 14, 1988
102-5-13 8-88
Debrowski, Sophie
School House Road
Cutchogue, NY 11935
Our records show that you recently had your cesspool/septics 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.`
The Operation Permit is issued by the Southold Town dlerk's
Office. The fee is ten dollars ($10. 00) for a residential system,
twenty-five dollars ($25. 00) for a non-residential system.
I have enclosed an Application for an Operation Permit. 'Please
complete the Application and return it to this office along with the
proper fee.
Enclosed you will also find an Informational Bulletin regarding the
Southold Town Scavenger Waste Treatment Facility. I hope this will aid
you in understanding the Scavenger Wastes Ordinance. Should you need
any assistance or have any questions, please do not hesitate to 'contact
this office.
Very truly yours,
0
obgoe ,,,..„..4 ii...-0444414,-..-
Judith T. Terry
Southold Town Clerk
Enclosures (2)
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