HomeMy WebLinkAboutDupay OFFICE OF THE TOWN CLERK • •civ fair�O
Town of Southold �� 3 �4
Judith T. Terry, Town Clerk '� =2
Town Hall,. 53095 Main Road oma;
P. O. Box 1179 cn `. `"; ��
Southold, New York 11971 O ' t`4' • �
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 304 - Residential X
Non-Residential
Fee $ 10.00
-Septic Cesspool x
NAME OF OWNER: Peter Slivka - Jay Dupay
OWNER MAILING ADDRESS: 65 Colin Street
Yonkers, New York 10701
OWNER PROPERTY ADDRESS: 545 Ryder Farm Lane
Orient, New York
OWNER TELEPHONE NUMBER: 914-968-7967
TAX MAP NO. : Section 15 Block 4 Lot 9
CROSS STREET: Park View Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New X Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: New System
Judith T. Terr
Southold Town Clerk
DATE: May 18,' 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 00 in,
Town of Southold �® ., CD Application No.C�Q 1/
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Judith T. Terry, Town Clerk ��o.. -_,4, + '` =4
Town Hall, 53095 Main Road #e„ '' .: Y '< Residential
P. O. Box 1179 cn __ ' ,._:; ' ' :` Non-Residential
.
Southold, New York 11971 4 '+ , 'x -1.-.T `,
Telephone o.( Y I.
(516) 765-1801
h'112..S ectorq.. TOWN OF SOUTHOLD
I SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
' OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.&6V
Fee $ /d _
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OWNER NAME: ;; 7- -(Q sib I/ kp - , biiii4 -f
OWNER MAILING ADDRESS: b5 Loll A) 57
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OWNER PROPERTY ADDRESS: S%& RTDt-1z - i9 I I8-
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OWNER TELEPHONE NUMBER: 7/44 - 96e-' 7947
J TAX MAP NO. : Section 0 15---
Block 0 4. Lot 0 7
CROSS STREET: PAIk U/ew tieni3
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 1-J
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.)
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RECEIVED BY: CZ i_c .
izr,ct.. Town erk's ffice
DATE:
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