HomeMy WebLinkAboutHelinski "1 \VOLite iI
1.
1.� p J►
JUDITH T. TERRY z Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .` Southold, New York 11971
MARRIAGE OFFICER Fax
®� ,�` Fax (516) 765-1823
®1 *� .� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2099-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HELINSKI, PETER F.
Mailing Address 1 P. O. BOX 35
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1570 PEQUASH AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6134
Tax Map No. section 103.00 block 11 lot 14.003
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 4/19/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
_ OFFICE OF THE TOWN CLERK •c.VFFD(,(��'
Town of Southold CApplication No.A Q ��
Judith T. Terry, Town Clerk �� 4 ,•"#,C" QG A %\1
Town Hall, 53095 Main Road " rte" U .G $10.00 - Residential
p. O. Box 1179 � ,3� . $25.00 - Non-Residential
Southold, New York 11971 O ® � ry
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
- OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. r:09 9
Fee $
DATE Cipij11 ,9g3
OWNER NAME: Ej E k Pk:L.0 144
OWNER MAILING ADDRESS: PO Box 35
C,ucctoGue N /. ( 1935
OWNER PROPERTY ADDRESS: (570 PEQ0-514 AVE
CATCAOG�E N,I• I 0 35
OWNER TELEPHONE NUMBER: 73144,(3L
TAX MAP NO: : Section (p 3 Block 11 Lot (14.3
CROSS STREET: HAW 3N
TYPE. OF ,SYSTEM: Septic Tank ( -New Existing X
Cesspool 52- New Existing X
Residential xNon-Residential
DATE OF PREVIOUS PUMP-OUT: 31((110 lq3
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.)
('/nv.St_ �.
Signature oicant
RECEIVED BY: if
Town Clerk's Office
DATE: 4/1/
1'•, , i , ,
' kicc, ,
. ,,I . ...
0
c3/
. 4,
.;\ \
i 5%
Ib' \
O- ti
31' 1 to
1 i
Z
i � w
9, No uSE I 3
I rr - J
I z1 < 2.0' •
2.1'
A zq1mo'
A'
f
I Ll
I a