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Home My WebLink AboutDroskoski 0WKOQire JUDITH T.TERRY t® Town Hall, 53095 Main Road • TOWN CLERK t ' g ; P.O.Box 1179 REGISTRAR OF VITAL STATISTICS • ' �, Southold,New York 11971 MARRIAGE OFFICER /L ®� Fax(516)765-1823 RECORDS MANAGEMENT OFFICER = �( � .16° Telephone(516)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. 3292-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner DROSKOSKI, JOHN Mailing Address 1 BOX 395 Mailing Address 2 City St Zip LAUREL NY 11948-0000 Property Address 1 1640 LAURELWOOD DRIVE Property Address 2 City St Zip LAUREL NY 11948-0000 Owner Telephone No. 516-298-8699 Tax Map No. section 127.00 block 5 lot 4.000 Cross Street PECONIC BAY BLVD. Issue Date: 12/12/94 Judith T. Terry Southold Town Clerk (TOWN SEAL) ISS ii iii "OFFICE OF THE TOWN CLERK �c�vFFO(,rc- Town of Southold • OG.� Application Judith T. Terry, Town Clerk r . y Town Hall, 53095 Main Road 8f: -< $10.00 - Residential P. O. Box 1179 cn �' i ;' $25.00 - Non-Residential Southold, New York 11971 •;f 0��$ Telephone Q� * `, (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /n•(y) ia` DATE 3/7 / OWNER NAME: y0h4) - 'Los OWNER MAILING ADDRESS:_aay,39 kg u/t/ N- 1 ) /f Vce- OWNER V- OWNER PROPERTY ADDRESS: �o l- a`•c(, IV- Y t 194 OWNER TELEPHONE NUMBER: flap 'l Pu RcLWoocj Es-1 ti - m rP - 5595 TAX MAP NO. : Section J 7 Block Lot CROSS STREET: c,-e.)/c. pay TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential 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.) igr'rature of ' pplica t RECEIVED BY: Town Clerk's Office DATE: • - • -- ',--.7- --'' ..-,-.-A.,:'-A.--r -77";:sA r:.-1"...';-r'A:,' C:I..."...'%:-..---' 'AI, Y.-•,--; '.---. ''.-. "- -117. 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' '.. , . . .. .., - , • ' : '-'' - :,. . .- . ,.... . , ,, .. ..., . - -,,': ,'• --;".'- - • • . . .- . ,, 4- TUTION.GUARAMET's A.sk rica TRA,bt.S.U.r...V.' - ----- - ' ..-. . 7----- -.-.----.. , . . TO ADDITIONAL INSTITUTIONS OR swstQuENT OWNERS, _ , .. " . . , - ,. , ' • • .