HomeMy WebLinkAboutElak OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
Telephone �l [ �►��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 25 Residential XXXXX
Non-Residential
Fee $ - pp
Septic Cesspool XXXX
NAME OF OWNER: ALEC E ELAK
OWNER MAILING ADDRESS: P.O. Box 296 Founrierg Pah
Southold, New York 11971
OWNER PROPERTY ADDRESS: Same
OWNER TELEPHONE NUMBER: 516 765-2084
TAX MAP NO. : Section 64 Block 4 Lot 5
CROSS STREET: Landon Road
TYPE OF SYSTEM: Septic Tank New Existing XXX
Cesspool New Existing XXXX
Residential XXXX Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 1, 1984
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Judith T. Terry
Southold Town Clerk
DATE: August 22, 1986 "
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK S�FFDC,�
Town of Southold �o CQG Application No.
Judith T. Terry, Town Clerk
Residential
Town Hall, 53095 Main Road 1
P. 0. Box 1179 Non-Residential
Southold, New York 11971 O
Telephone �l Y►���
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE _19u( 2- -1 9S-6
OWNER NAME:_) Slue
OWNER MAILING ADDRESS: 7axq �
OWNER PROPERTY ADDRESS: �®ceOAS e?A-r
&,jrhfc d Q AL Y 11971
OWNER TELEPHONE NUMBER: sS/6 - `7 s- .2
j TAX MAP NO. : Section Block Lot
CROSS STREET: rr'6v1,lnffa 'f NTh
TYPE OF SYSTEM: Septic Tank New Existing
cx
Cesspool V/ New Existing ,r-
,Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: °]- ! q- 8-6
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.) _ Y
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Signature of Applicant
RECEIVED BY:
IToWn CJerrk' Office
DATE