HomeMy WebLinkAboutKawecki Town Hall, 53095 Main Road
!j ji P.O. Box 1179
,,,4C �� "% Southold,New York 11971
JUDITH T.TERRY �� � TELEPHONE
['OWN CLERK , 7111S�r (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. 3599-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner KAWECKI, BRUNO
Mailing Address 1 615 KNOLLWOOD LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 615 KNOLLWOOD LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4095
Tax Map No. section 107.00 block 6 lot 8.000
Cross Street GRAND AVENUE
Issue Date: 4/07/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• ...
OFFICE OF THE TOWN CLERK .0 FFA
Town of SoutholdG Application No. J
Judith T. Terry, Town Clerk �� " y
Town Hall, 53095 Main Road ,-:�, - $10.00 - Residential
P. O. Box 1179 nx`-. # Lta �' $25.00 - Non-Residential
Southold, New York 11971
Telephone �.( �����
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ • DATE /4/9NL c/, l/
9'1%
OWNER NAME: 13 U /vv ,A WW&1/(/
OWNER MAILING ADDRESS: C1,5 //U06-L//0094 L /4
/174177/7 'c/� /0 Y. 1/ P5'�
OWNER PROPERTY ADDRESS: ,'4/L(/2
OWNER TELEPHONE NUMBER: 5'14- eio 7S
TAX MAP NO. : Section l 0 Block Lot
CROSS_ STREET: ,v " uEA9c
TYPE OF SYSTEM: Septic`sTank '� ''4New Existing
Cesspool New Existing
Residential f Non-Residential
- t
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.)
• -
Signature of Applicant
RECEIVED BY:
Town Cler,k's•-Office
DATE: y/9,,_
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SURVEY OF;
PROPER TY
ORESIDENTIERTIFIED TO A!MORTGAGE SERVICE T AT MA T TI T UCK
INCORPORATED OWN OF SOUTHOLD
EQUITY
ARK ACT INC.
McKEE
MSUFFOLK COUNTY, IN. Y.
PAUL J. McKEE 1000 — 107 - 06 08
Scale 1" - 40'
May 18, 1989
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Prepared in accordance with the minimum , i',• •, ;��'' m1
standards for title surveys as established -_ 1,?t f,;,, • N.Y.S. LIC. NO. 49668
by the L.LA.L.S.and approved and adopted l
1 for such use by The New York State and s NI .0,9i47 YORS, P.C.
Title Association.
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SOUTHOLD, N.Y. 11971
89 - 246