HomeMy WebLinkAboutHelinski OFFICE OF THE TOWN CLERK • .c,OfO(,Xi
Town of Southold Q Olj
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Judith T. Terry, Town Clerk • �;_ I�
Town Hall, 53095 Main Road
P. 0. Box 1179 = 14.7tAftss
Southold, New York 11971 p'® ••
Telephone "'Ol %NO •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 385 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: John S. Helinski _ —
OWNER
-=OWNER MAILING ADDRESS: 9 Madison Street
Greenport, New York 11944
OWNER PROPERTY ADDRESS: 9 Madison Street
Greenport, New York 11944
OWNER TELEPHONE NUMBER: 516-477-2081 •
TAX MAP NO. : Section 33 Block 5 Lot 22
CROSS STREET: Route 48
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Approx. 1982
'Judith T. Terr
Southold Town Clerk
DATE: August 5, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ���FFO
Town of Southold 0����_- - C& 3Application No. 25
Judith T. Terry, Town Clerk % y*aq.
�-� � � i . .G Residential
Town Hall, 53095 Main Road cryn , -
P. O. Box 1179 ;4 ' .' Non-Residential
Southold, New York 11971 O • -•$
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Telephone .'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. gS--
Fee $ /0 s
DATE ' ( 1 �S /
OWNER NAME: vS� S, )... a,,_, �T \C�
OWNER MAILING ADDRESS: C.0 '61A- S. L'
Ct,
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OWNER PROPERTY ADDRESS: ? Wet ,
OWNER TELEPHONE NUMBER: `Ssi Lo — /1--rn .-C) k
TAX MAP NO. : Section S3 Block 6--- Lot 2 -2---
CROSS
ZCROSS STREET: 1-6--- ,..
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential X Non-Residential
- DATE OF PREVIOUS PUMP-OUT: t Cl S--2 A CQ 4 v>
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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Signature of Applicant
RECEIVED BY c,
R ``=dgPown erk's Offic
DATE: AUG 041997
Town Clerk South®Id
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