HomeMy WebLinkAboutDroskoski 04° air
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Town Hall, 53095 Main Road
P.O. Box 1179
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04 Southold, New York 11971
JUDITH T.TERRY _of I J TELEPHONE
TOWN CLERK !!� (516) 765-1801
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. 904-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DROSKOSKI, JOSEPH
Mailing Address 1 ROUTE 48
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 ROUTE 48
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3389
Tax Map No. section 51 .00 block 3 lot 10.001
Cross Street CLARK ROAD
Date Of Last Pump Out 0/00/84
Issue Date: 11/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c3\\VFQ( '
Town of Southold �% CQG= Application No. 9d
Judith T. Terry, Town Clerk �� t`,' '.
Town Hall, 53095 Main Road r ..1 1 Residential
P. O. Box 1179t- : , *r Non-Residential
Southold, New York 11971 O }® 1'",,%• *'STelephone _e.( It '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. qIL-
Fee $ 0 "-
C •
DATE / 0 Try 7-15"
- OWNER NAME: Je--- /94_� r4 5 "G!
OWNER MAILING ADDRESS: W/?.1. ----- r
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OWNER PROPERTY ADDRESS: -
OWNER TELEPHONE NUMBER: (3l ‘ --26 Aillp,
TAX MAP NO. : Section 5, Block 3 Lot r��
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CROSS STREET: 4/0 4C (' Y,F7
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing L
Residential t/ Non-Residential
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DATE OF PREVIOUS PUMP-OUT: 04 ,„. --ems „/f 7
LOCATION MAP: Must be attached hereto before perm t may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
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1 ' /_.,,L., <7. e
I % i+natu "' of Applicant •
RECEIVED BY: `4 b�d `_.�_�1
wn I lerk's tffice
DATE: (.4/Pg/ D
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