HomeMy WebLinkAboutSidor, John III •
�O��SVFFO'"
,, ► o
ELIZABETH A. NEVILLE �� y Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
',
MARRIAGE OFFICER �i �IFax(631) 765-6145
RECORDS MANAGEMENT OFFICER = of �a���o Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �1
OFFICE OF THE TOWN CLERK
SOUTHOLD1I$ g rf4 l SAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4111-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner SIDOR III, JOHN & CAROLYN
Mailing Address 1 10845 SOUND AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 4160 WICKHAM AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 631-298-2170
Tax Map No. section 107.00 block 10 lot 3.001
Cross Street MARYS ROAD
Issue Date: 11/16/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK IS WFOUrC
TOWN OFSOUTHOLD Application No. ///
L1ZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential Z�
P.O.BOX 1179 cn
SOUTHOLD,NEW YORK 11971 O1� $25.00 - Non-Residential
Telephone 4'.j * i •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION.
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE I I
OWNER NAME: T-6.110 *- &Iilv Slaor AIL
OWNER MAILING ADDRESS: jog45 Sona Pt-u€_
ck. t) (1
OWNER PROPERTY ADDRESS: Li ROO LUc i o.rr rrvt.
HA- %iv ck tJ`I 1 q5 .
OWNER TELEPHONE NUMBER: (,3)- ( q $•.a no
TAX MAP NO. : Section WI Block 10 Lot 3
CROSS STREET: Heuit Vct
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.)
CAA i
gnat e of falicant
RECEIVED BY:
Town Clerk's Office
DATE: 7///.6j/�'/
ARTCO DRAINAGE CORP.
P.O. BOX 1132 MATTITUCK, NEW YORK 11952
(631) 298-9660
Health Department Ref. No.: R10-00-0225
Name of Applicant: Mrs. Catherine Sidor Phone: 631-298-2170
Address: Wickham Avenue
Property Location: Southside of Wickham Avenue
Hamlet: Mattituck Township: Southold
Subdivision: Lot #: 2
Type of System Installed:
Septic Tank
(a) 1000 Gallon square tank
(b) Type: Precast
Leaching Pools
(a) Number and size of pools: 2 - 8'diameter x 6' deep leaching pool
(b) Type: Precast
I hereby certify that the private subsurface sewage disposal system described above has been
installed according to current criteria of the Suffolk County Department of Health.
Date: November 13, 2001 Signature: b
Title:. President
License #: 206W