HomeMy WebLinkAboutDeerkoski ti 1
OFFICE Of jHE TOWN CLERK sC���FO[�`+G
TOwn - f Southold s' _
Judith T. Terry, Town Clerk ; � .
Town Hall, 53095 Main Road
P. O. Box 1179 $�
Southold, New York 11971 - ;O`_ -���-*
Telephone _ •
Kt * ,
(516) 765-1801 y'
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ' 109 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Patricia B. and Joseph A. Deerkoski
OWNER MAILING ADDRESS: 385 Cindy Lane
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 3855 Cindy Lane
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4222
TAX MAP NO. : Section 114 Block 10 Lot 16
CROSS STREET: Deer Drive -
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1975
Judith T. Terry
Southold Town Clerk
DATE: October 22, 1986
(TOWN SEAL)
co ,.�
OFFICE OF THE TOWN CLERK �COFQ(K��=
Town of Southold 0�� ' CDG', Application No. /0?
Judith T. Terry, Town Clerk �r A;' I Residential Town Hall, 53095 Main Road g 4
P. O. Box 1179 u' . a z Non-Residential
Southold, New York 11971 O: n .$
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Telephone °
(516) ,765-1801
TOWN OF SOUTHOLD
REUIVED
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OCT 221986
Tfiwn Ctork Southold APPLICATION r
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit t o. GO,
Fee $ /Q /)'t)
. 4.7#/- .414. . 6_ DATE /OA
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OWNER NAME: ..,J;',5"..? 4 k & �/
OWNER MAILING ADDRESS: .:5 C/71.
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OWNER PROPERTY ADDRESS: ,, .� / f `4A . n Air / _ �' ,
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OWNER TELEPHONE NUMBER: �J2LI/ '(,79(f.- V2/2---
TAX MAP NO. : Section
/ `7 Block /D Lot / '
CROSS STREET:
TYPE OF SYSTEM: Septic Tank V17,4<lew
New Existing /Cesspool Existing a// i
ResidentialNon-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.)
i
. CO4 166/4 t
\\ diFar _ „2- V 19 -
J1i:7..LL
^ :i(nat.re of Applicant
RECEIVED BY: /
Town Clerk's Office
DATE: