HomeMy WebLinkAboutJablonski (2) f
OFFICE OF THE TOWN CLERK 6 r �FDjj(�,O _
Town of Southold � } 1 4,
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road c
P. O. Box 1179 ' .
Southold, New York 11971 p �.
Telephone �l
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation- Permit No. 552 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Leslie Jablonski
OWNER MAILING ADDRESS: 1 Village Lane
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 1 Village Lane
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8689
TAX MAP NO. : Section 114 Block 6 Lot 6
CROSS STREET: Marys Lane and Mill Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 6-87 - -
dirsrio
Judith T. Te y
Southold Town Clerk
DATE: December .29, 1987 -
' / /, `
(TOWN. SEAL)
_
OFFICE OF THE TOWN CLERK �c�vFF0lf(�'- '
Town of Southold %&'44,07-,,, CQ Application No. .5---,...5-17Z---)
Judith T. Terry, Town Clerk �� ,
Town Hall, 53095 Main Road ,; .:-.4c.‘1 Residential
P. 0. Box 1179 U' =: i % Non-Residential
Southold, New York 11971 s _ +' r �$
Telephone42;-.-
(Y ��� 'o•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE //al- rc9e) ---S7
4E-51",' ---Ls
OWNER NAME: A-67,6-71 -/-2--%__
OWNER MAILING ADDRESS: / L' &cc e 4 -4-
TO irr�i/-0 4 / / 9 J---
OWNER PROPERTY ADDRESS:
/-.3--c,„„ CLIA52-c-c—C,
OWNER TELEPHONE NUMBER: "S7 ‘) —aL9e9 E96e2
J TAX MAP NO. : Section '/q` & - Block Lot
CROSS STREET: I1P . WkseQ_t- illa-47 e (7 Je C20c-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New xisting
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: "''g- 7 " a- g 7
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.)
C --4-1-1 --e—c---- - Vic.
/ Signatureof pplicant
RECEIVED BY: ‘ 1 .'
le RECE,;,,,n-oTown 'lerk's fice
DATE: DEC 2 9 less
Imo Clerk Southold
2
s
.
.
� / �
1,- �� �= ^ / w/ ~ � ���<� -�
� , `^ [� �
.
. �
.
etsr
_ — _ ___ -_ - '������_���_ _-_--- __ -- - _- - --''----- _-'__� _-'_ -_--- - -_- _--- -' - -
140r7-4 < 11 ---=.)_ --S60771 ,
e); i(a_7 e A 4.,/,:s - i
t ti‘f lieL7e. LA-at tia)931'• . ,
/-\\-_-_- _—_------- \
_ _ _ ). ,-1
. 5 Qt
- . I 1(511 51.0.•e-1 e:'---- _ _ _ _
. \C:1 [ _
I \ POI'41
} ../ /
. \ '
,
' - - ----'
,
- /' --_ -_- -- '-
. i
,
- - ' -- -_ � - - - - iii :
---:
�~�, ' (cr_^/ �~ " _, � /`~~~. -~~-
- -'- �__- -_ __ _ '-_---' - - - -
. , '