HomeMy WebLinkAboutDoroski (3) OFFICE OF THE TOWN CLERK cOF
Town of Southold01 CDG -
Judith T. Terry, Town Clerk ` �
Town Hall, 53095 Main Road 8 # ..Y�� -
P. 0. Box 1179 % En � �
Southold, New York 11971
Telephone _l
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 71 Residential XX
Non-Residential
Fee '$ 10.00
Septic Cesspool XX
NAME OF OWNER: Theodore E. Doroski
OWNER MAILING ADDRESS: P.O. Box 42, Main Road
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: Main Road
Cutchogue, New York
OWNER TELEPHONE-NUMBER: 516-734-6850
TAX MAP NO. : Section 97- Block 5 Lot 5
CROSS STREET: Harbor Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool xx New Existing xx
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 1, 1986
efe04;a0114:07...4 .
Judith T. Terry
Southold Town Clerk
DATE: September 26, 1986
(TOWN SEAL) )-
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OFFICE OF THE TOWN CLERK CCarr/
-'_
Town of Southold f>, Application r�/
' Application No. 1
Judith T. Terry, Town Clerk .
Town Hall, 53095 Main Road c ' Residential
P. O. Box 1179 533 tiV `. Non-Residential
Southold, New York 11971 04� `'. �`
Telephone 0(
(516) 765-1801
RECEIVED TOWN OF SOUTHOLD
SEP 261986 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town Clerk Southold
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 7/
• Fee $/d
• DATE 9 -- ,2. 8 6
OWNER NAME: TQo /-7 bo.,otr,ti
OWNER MAILING ADDRESS:}Pd,6'ex-¢.2._.. /yr�ini ,P�/
6/.1.74CA0,Qe yy ,/ }-
OWNER PROPERTY ADDRESS: Ef,4",,
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 97_ Block — S Lot —
CROSS STREET: A/0/1E i c` ert-,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing V
Residential '� Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7- f - ej ‘
LOCATION MAP: Must be attached hereto before permit may be issued.
cj (Locate building and system; give north arrow and feet
a a of distance, approximately, to building and closest road.)
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,er. 4/e/
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/ Signature of Applicant
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RECEIVED BY: a_cc-
Town erk's ffice ()\\
DATE: XLe rel li
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