HomeMy WebLinkAboutDoubrava ;Jo seguriv,t,
oz
Town Hall, 53095 Main Road
., P.O. Box 1179
__ ��� ��®�0 Southold, New York 11971
JUDITH T.TERRY FAx(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SIMEIIDovitasW ASffIBROSSIR. BESSAITAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1186-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DOUBRAVA, JOSEPH
Mailing Address 1 1455 OLE JULE LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1455 OLE JULE LAN E
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4704
Tax Map No. section 122.00 block 5 lot 1 .000
Cross Street NEW SUFFOLK AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 7/19/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i . '
OFFICE OF THE TOWN CLERK ' . S��FD(,�- '-
Town of Southold 0�� ..: .NC'�G•_ Application No. �j
Judith T. Terry, Town Clerk . h„> y
Town Hall, 53095 Main Road 3"" h,:,7 r ` $10.00 - Residential
p. O. Box 1179Ln k u�.,., �� $25.00 - Non-Residential
Southold, New York 11971 O u° 'e` ` .
fit'.•
•
Telephone ®1 `�� '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1 ) O,b
Fee $ "l L$ 1a61
DATE 7 `-r--gyp
OWNER NAME: .3-0 5 e o/i Ze'///ge l/r1
OWNER MAILING ADDRESS: /Y.51-13` pea AGe z-4.
44 me cc' /1l.f // 1s"2._r
OWNER PROPERTY ADDRESS: S,,4_49,
OWNER TELEPHONE NUMBER: 2f7 '/las/
TAX MAP NO. : Section /, a? Block Lot I
CROSS STREET: / iti .ie,rrrtc' ,*o
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ,./ New Existing
Residential 1-7- Non-Residential
DATE OF PREVIOUS PUMP-OUT: /,) '7‘.
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.)
4 /
i
na ure of Applicant
igt
111,
RECEIVED BY: � i /. : _.,/ ..'o n CI Yr s •ffice
DATE: - i
•
'rn
r
.�! •_ '•�.
•
•
li _ _ -�} rr`;;aaL� -, 7,33 ,.moi '1 0 +- 1� _ `*• . ..o-j.• ..i: ,.` _ _ - _,••.-• 'rv-. Y'?,L -X ). i{ ••`c�'r,.s� w,_- • _ `•TI
.- _- ' _i rh _ c�, `,..'•;r : K . y _...�^`"_�^▪ M .• .-- ,4rsi%... ,¢.�y•,,,4�.:t,- _ •. _�i.�.'r_....-47,.......,-7, -` ; ... V..ty`�yfl`J•▪ `• •ri`.SY {'.y^_:J t-ayY.•JL'e_.y - �j..,.
• • .+..• - - qn�r �+-R',r �P �y,.S-.r, ✓�,._� - �, F� • -'.- r[. - J.'.i a% r`(;''t ;` 30 Y� �: ••-•••i,•,-- Vii+ -• • • • .
-' - - :r_ ��,r.�:.•.� .k - .•.14 s76d-_ rti ,,, -••�-'f ,',- _ _ _,'•y,•' `••'� -- •t1,Y-: '''fiv ,L;• }� r 11': f+•`•Ij•••' ,;, L. �'y
," -,- - -- .- - ▪ :-1L - ay?.fi ry�.r' Fly ;f-•.. -3x.,•l' _ ..y '; _ •���,:._r.-` ,..,,,.--A.-t� _. .,�,: .:r" •• •.1 -4,...,,..-e-,� -s--_ .{�-:
-- - .�.._ - _ _ s - _ _ - r.l;h •ai' •a"G,•'S •'1\.t=. . -- • - -.,Er_ _-,,,i - r!'- - `+,'4,tit_"1.2r' • efr:r' '1'..7.-;-- 'r - ,+•-
=_ - r - T,... ,a=•v:`.s,�,•� +.�'-)•_ - -.i