HomeMy WebLinkAboutDoroski (2) go- ,AVuur
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Town Hall, 53095 Main Road
sttVii` P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY
ilFAX(516)765-1823
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TOWN CLERIC
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. 981-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DOROSKI, STEVE J.
Mailing Address 1 NORTH ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 DEPOT LANE
Property Address 2
City St Zip CUTCHOUGE NY 11935-0000
Owner Telephone No. 516-765-3600
Tax Map No. section 102.00 block 2 lot 2.003
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/00
Issue Date: 1/09/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �SVFFO(,r�'=
Town of Southold CQGy
' , Application No.
Judith T. Terry, Town Clerk .� ��r4 �' .-Fr
- Residential
Town Hall, 53095 Main Road o ,,.
P. O. Box 1179 u-3 PW. Y' ,`' Non-Residential
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Southold, New York 11971 O ® -. t % -v0
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Telephone . l Nt ,.�
(516) 765-1801
REM ' TOWN OF SOUTHOLD
12 1988 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town Clerk Southold
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. Sri
Fee $ f o,.D=
DATE /0/6,IP
OWNER NAME: T,C-U[= J .. dt20J/c
OWNER MAILING ADDRESS: �c212-71/ 49/4-1)
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OWNER PROPERTY ADDRESS: �LPDT
acrc aa.6, et, 11 Qs3'
OWNER TELEPHONE NUMBER: 6"/6 - 76s--3676)0
TAX MAP NO. : Section / 0a, Block —01 Lot v2,3
CROSS STREET: l20ct2' AS--
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 2/S �
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.)
tur-`07417 ;Dlica
RECEIVED BY:
Town Clerk's Office'
DATE: