HomeMy WebLinkAboutKavazanjian OFFICE OF THE TOWN CLERK sFD
Town of Southold COG
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971 Q` 4-�;�
Telephone - 0( 41
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 198 Residential x
Fee $ 10.00 Non-Residential
Septic Cesspool •X
NAME OF OWNER: Thomas and Mary L. Kavazanjian
OWNER MAILING ADDRESS: 125 Oxford Blvd.
Garden City, New Y&rk 11530
OWNER PROPERTY ADDRESS: 120 King Street
Orient, New York 11957
OWNER TELEPHONE NUMBER: 516-742-4360
TAX MAP NO. : Section 26 Block 2 Lot 3
CROSS STREET: Willow Terrace
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terry
Southold Town Clerk
DATE: January 9, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK C.OFU(����
Town of Southold &,% �k Y CS ' , Application No. /9er
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ' : Residential
P. O. Box 1179 t=1231e.; . Non-Residential
Southold, New York 11971
Telephone .( ‘IkNa0
(516) 765-1801
RIMED TOWN OF SOUTHOLD
OV4Ve SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Ion CIO South®1d
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. / 9P
Fee $ /p a'Sz
DATE _NO V' ,i r,
OWNER NAME: ' 4 "may i f K/wizmvf/m/
OWNER MAILING ADDRESS: /e2.( OXFOR- /JC• \//),
61V,1) c�i N� / l/S 3a
OWNER PROPERTY ADDRESS: PA kii#Ve. 577
ORWT N , 7
OWNER TELEPHONE NUMBER: („///)) —q360649060 Ctry)
TAX MAP NO. : Section Ce Block Lot 3
CROSS STREET: G,L.O GJ 7F-669-6,6-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: &OR /► ',
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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Signat re oftplitnt
RECEIVED BY: v. �` • . .est
RECEIVE-6own dA rk's Office
DATE: 0 9 1087
Town Clerk Southold
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