HomeMy WebLinkAboutDroskoski (2) ;OW lig
4,? fia ` Town Hall, 53095 Main Road
®� Vii`' P.O. Box 1179
�®� �� , 4! Southold, New York 11971
JUDITH T.TERRY �s�'� r FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1381-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DROSKOSKI, STANLEY & PATRICIA
Mailing Address 1 MAIN ROAD, BOX 34A
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 531 STERLING PLACE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-323-3528
Tax Map No. section 34.00 block 3 lot 4.000
Cross Street KNAPP PLACE
Date Of Last Pump Out 0/00/00
Issue Date: 2/09/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 0F.O�
Town of Southold , CQG Application No. e/
Judith T. Terry, Town -Clerk � �`'� $10.00 - Residential
Town Hall, 53095 Main Road �'
�.l'7 ��� 't Ys;k�`
P. O. Box 1179 �; ,�LZ ; $25.00 - Non-Residential
Southold, New York 11971 O ®. •�
Telephone •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0,M
DATE --,/,)/?0
'OWNER NAME: / �•e/G//9 t0/(0• /<0-5-1c/•
OWNER MAILING ADDRESS: 41//v /eD4-i> /COX --F0./9
OWNER PROPERTY ADDRESS: L5:�l S G fn / c'e
OWNER TELEPHONE NUMBER: ,4I(/ 3 43/��� Q,
TAX MAP NO. : Section 3`/ Block 3 Lot 7
CROSS STREET: /f la��c e.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential >( Non-Residential
DATE OF PREVIOUS PUMP-OUT: 12/ //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.)
Signature of Applicant
RECEIVED BY: 4-4--')<-a-'‘•-P
Town Clerk's Office
DATE: t, f, ( SO
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