HomeMy WebLinkAboutDeerkoski I -
cam- _n - 1
Town Hall, 53095 Main Road
jam '� ®� P.O. Box 1179
4� ® � Southold, New York 11971
JUDITH T.TERRY
Ne TELEPHONE
`��,�� �=��
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3594-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner DEERKOSKI, DAWN AND JAMES
Mailing Address 1 260 DEER DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 260 DEER DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-6278
Tax Map No. section 114.00 block 10 lot 2.000
Cross Street WESTPHALIA ROAD
Issue Date: 3/06/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold Application CQG:� Application No.3 5 7_7
Judith T. Terry, Town Clerk
Town Hall 53095 Main Road Vit, $10.00 - Residential
P. O. Box 1179 u1 " ` tri z $25.00 - Non-Residential
Southold, New York 11971 f,o���`
Telephone _ ?(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
/> 0
Fee $ �v
DATEe C��.CC /?97
OWNER NAME: ����,�%C
OWNER MAILING ADDRESS: 4e,c(Zi/2,6biti
.
v = //74Z,
-OWNER PROPERTY Y ADDRESS:
OWNER TELEPHONE NUMBER: S/6o- 7J7'C0.2 78
TAX MAP NO. : Section /6'1, 00 Block /D Lot J. poo
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New __ ___Existing
Cesspool New‘31( 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.)
V
Sign ure of Applicant
RECEIVED BY: ` 4111.a. : /./
own ' lerk's Office'
DATE:
t
1 f IIf
`.-. `
1
1 _ i, , _
i 1 ,
{ 1 i 1 -
1 i 1 I �
_ ___. 1
1 ,
LT ,
, i
r •
, ,
.. _ , 1 . 1 iji
I
lii i
1
I
___ i I . _. .
� N
f
dk
acv
Ii
m '��
1111111W.‘ ! .__1� .L - _ ;
E 0
•
. '''''' ' H / 0 I
i # I
I
# + i , t
i , I _.{_ N
T \�' I
No l �-`�� -� 6•; .
.__\,..._.) 1 c..--•-,:-.P 09 q-t 4.)1 37NI
er