HomeMy WebLinkAboutKauneckas FPI i Town Hall, 53095 Main Road
�® ®�/ P.O. Box 1179
-............40 it ..,p),... Southold, New York 11971
JUDITH T.TERRY „iii,/'' FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1571-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KAUNECKAS, LOUISE
Mailing Address 1 8500 ALVAHS LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 8500 ALVAHS LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6682
Tax Map No. section 95.00 block 4 lot 3.002
Cross Street ROUTE 48
Date Of Last Pump Out 4/26/83
Issue Date: 10/30/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
„
OFFICE-OF- THE TOWN CLERKS�FFOUr
Town of Southold Q _ ��'� Application No. /Sift”
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road y. :4 $10.00 - Residential
P. O. Box 1179 cn = se: _W
;�P $25.00 - Non-Residential
Southold, New York 11971
Telephone eei * %t"6
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ C.
DATE O CI _ / T 1J
OWNER NAME: to_c_t_t tea
OWNER MAILING ADDRESS: F „Co y d
ade__Q-61,„ q_ #4 , y I 3
OWNER PROPERTY ADDRESS: evA, --
OWNER TELEPHONE NUMBER: 5 ( ( — 9 3 Lf -- 6 6
TAX MAP NO. : Section 15 --- Block 4-3., Lot
CROSS STREET: 4-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool % New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ar,t4 g (o / F i
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.)
n t re of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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