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HomeMy WebLinkAboutHelinski (2) OFFICE OF THE TOWN CLERK ���fli I Town of Southold q�._ Judith T. Terry, Town Clerk F r Town Hall, 53095 Main Road � , P. 0. Box 1179 C!1( �. � : r'T1 ..fix � �r' 4�� Southold, New York 11971 F! " �'Z- • Telephone =Q( a - (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 554 Residential X Non-Residential Fee $ 10.00 Septic Cesspool X NAME OF OWNER: Ziqmund Helinski OWNER MAILING ADDRESS: P.O. Box 361 Southold, New York 11971 OWNER PROPERTY ADDRESS: Tuckers Lane Southold, New York 11971 OWNER TELEPHONE NUMBER: 516-765-2513 TAX MAP NO. : Section 59 Block 4 Lot 3 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: 1984 Judi h . Southold Town Clerk DATE: December 31, 1987 (TOWN SEAL) t OFFICE OF THE TOWN CLERK iCOFai Town of Southold o CSG y-27/Application No. Judith T. Terry, Town Clerk :",' - o► Town Hall, 53095 Main Road Residential P. O. Box 1179 sr's c* ' . Non-Residential Southold, New York 11971 ®. - � ,�'� Telephone : .� a `' (516) . 765-1301 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION - - --- for-' ''' -- OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. cc r Fee $ ,1 , , er DATE ` 2' 3/ - 7 OWNER NAME: /4) ! OWNER MAILING AR�S`3� AO -7,L.P Ji°-', Y OWNER PROPERTY ADDRESS: ,�' OWNER TELEPHONE NUMBER: 7CP — a 5--1 3 TAX MAP NO. : Section S� Block Lot ' CROSS STREET: R, A, 9 C © (A- R , .___,-i TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing _______ Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: t G(61 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.) 0 7 Signature of Applicant RECEIVED BY: ne4 -,ag, , _ RECEIVE!Tow Clerk's Office DATE: DEG 311907 Tnuun Clerk Southold 1 ' -_- '- , 1 1A.1 s-,00<I :. 'IV -- . - i- 4 l'Ve i Li c" . ' Tectll 1 ----- . p61 ez) c 046 (..3 1 I 6 PI ciw , ii I -. i