HomeMy WebLinkAboutHajek OFFICE OF THE TOWN CLERK • FU
Town of Southold ��F �C�
Judith T. Terry, Town Clerk � 1.g4-$
Town Hall, 53095 Main Road c
P. O. Box 1179 u � ' �••
Southold, New York 11971 \ Q •`
Telephone �O •,
(516) 765-1801
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 441 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Frank Hajek
OWNER MAILING ADDRESS: Box 105.
New Suffolk, New York 11956
OWNER PROPERTY ADDRESS: 15305 New Suffolk Avenue
New Suffolk, New York 11956
OWNER TELEPHONE NUMBER: 516-734-6591
TAX MAP NO. : Section 117 Block 6 Lot 15
CROSS STREET: Corner lot - New Suffolk Avenue and Grathwohl Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Approximately 1984
Ar47441:111°.
Judith T. erry
Southold Town Clerk
DATE: September 28, 1987
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK COFOCA-
Town of Southold �� .: CQ _ Application No. 4/41/
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 4x RResidential
:'�
P. O. Box 1179 crs WtNon-Residential
Southold, New York 11971 c;:> ' % ••'
Telephonet.
it I .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
fo r-
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 419/
Fee $ -
DATE Sept al. /9.P7
OWNER NAME: !—P A /U J E/C
OWNER MAILING ADDRESS: R61( /0 5 Nev., So F OL)
A/ew Su PFO1IC ) i• 11 96-C,
OWNER PROPERTY ADDRESS: /5-2 os /Veva Ju Pdd Li( 40E
/dew EupgoLIC N. 2 // 115-C
OWNER TELEPHONE NUMBER: 7341 6 S / /
TAX MAP NO. : Section /17 Block 6 Lot f'J
CROSS STREET: ce , 44' f,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential V Non-Residential
- DATE OF PREVIOUS PUMP-OUT: ,Vfl .oY /9Py
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
RECEIVEDTc..-
Town Jerk's (ffice
DATE: SEP 2 81997
Town Clerk Southold
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