HomeMy WebLinkAboutWilcenski, Donald / ,��,
ELIZABETH A. NEVILLE j� e„,yd; Town Hall, 53095 Main Road
TOWN CLERK ` y ; P.O. Box 1179
v Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS �� Fax (631) 765-6145
MARRIAGE OFFICER tel,
RECORDS MANAGEMENT OFFICER ��y"'/Q a �� Telephone (631) 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. 4037-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner WILCENSKI, DONALD & NATALIE
Mailing Address 1 2465 FAIRWAY DRIVE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 2465 FAIRWAY DRIVE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 631-734-2258
Tax Map No. section 109.00 block 5 lot 14.022
Cross Street GREENWAY
Issue Date: 6/30/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
4 9 " ".•�
OWN
RK
�' OFFICETOWNOFSOTUTHOLDE ec‘S�FFU(,r`�lj': Application No.�( __J_2
ELIZABETH A.NEVILI.F,TOWN CLERK ' �� $10.00 - Residential
P.O.BOX 1179 cn
SOUTHOLD,NEW YORK 11971 1,,Zi $25.00 - Non-Residential
Telephone *el * 0-0/
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE a U V 2'7, ,2000
OWNER NAME: 1 , c4- 060.2A1( e \I.1 ,1c-evlSI_ ,'
OWNER MAILING ADDRESS: 2-46V Ftrvvo p e-'‘ v•-e.
C 4 4-c.. .09 v t 1 iv ti,,/ ',,,Ac. I i q
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: ( 3/ - 73 51 - ZZSE'
TAX MAP NO. : Section /O 7. Block 5 Lot nta 02Z
CROSS STREET: VreavitN
1 � 9Sb
X
TYPE OF SYSTEM: Septic Tank New ,( Existing
vwC
El)) qf� k&ir . Cesspool 3 - X New )( Existing
Residential X 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.)
2-J
Sign ure of App icant
RECEIVED BY:
Town Clerk's Office
DATE:
•
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Dwelling Lot #18
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ars
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C$ ,_ violation ofasection 7209, sub-Oiv15i0r
1 fy� Neu York State EOuca
` , .�ti\�ii�~ *, 'Only Copies from the original of t
t , marked with n ginal of the land
TENT FOUND ♦ { _;A,kii�:� stamped coal shallbe considered to Pe
' -Certifications indicated hereon signify
FOUND •vti c / �'' st ingaCooesd�rPpactdcenf orcLandnSurve
V �O 171^,` J� Oy the New York State Association of Pr
0 V� 0' Land Surveyors Said certifications snal
V / to the person for whom survey i
LAND S// and on his behalf to One tyle pany s
������ tai agency and lending lost O to,fontu1 steel n
to the assignees of the lending institution.
•F OR 1.01 ACRES
nonearent transf cble to additional in
JOHN C. EHLERS LAND SURVEY
I"= 50' 6 EAST MAIN STREET N.Y.S.LIC.NO
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