HomeMy WebLinkAboutKiski OFFICE OF THE TOWN CLERK ' i
Town of Southold ������O�COG
Judith T. Terry, Town Clerk f. J'
Town Hall, 53095 Main Road
P. O. Box 1179 •
Southold, New York 11971
Telephone
(516) 765-1801 ''�
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT -
SEPTIC TANK or CESSPOOL
Operation Permit No. 243 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Bruno and Eileen Kiski. Jr.
OWNER MAILING ADDRESS: 18 Middleton Road
Greenport. New York 11944
OWNER PROPERTY ADDRESS: 18 Middleton Road
Greenport. New York
OWNER TELEPHONE NUMBER: 516-477-1207
TAX MAP NO. : Section 40 Block 51 Lot 16
CROSS STREET: Wilmarth Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New x Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: November 1986
Judith T. Terry
Southold Town Clerk
DATE: March 31 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK __ �j�FFQ(�•�'=
Town of Southold ‹, • CQ Application No. R5L.?
Judith T. Terry, Town Clerk �► //
Town Hall, 53095 Main Road x' ' - r< Residential
P. O. Box 1179 cn 7:ka gx,,qtfi ;' Non-Residential
Southold, New York 11971 0�s%, ' a
Telephone o,( se ,'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. a 9°3
Fee $ /b'
DATE 3/24/g/
OWNER NAME: "ggU/YQ t i& Ai ITIS
-374
OWNER MAILING ADDRESS: fg j'li DimEi qj11/ gD
G EAJpoigr- I. my m N
OWNER PROPERTY ADDRESS:
SAME f )/3o►l
OWNER TELEPHONE ,NUMBER: 576 14)77 f,207
TAX MAP NO. : Section , O . . Block Lot
CROSS STREET: ,),(6,(/),-yz_a441,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool )4 New x Existing
Residential ,,/Non-Ressidential
N' V
DATE' OF PREVIOUS PUMP-OUT: /9r,
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.)
(2L0
Sig41,1 ture (Applicant
RECEIVED BY: _ctc..--sV.
Townerk's Of ice
RECEIVE'
DATE:
MAR Z7 12
Town Clerk Southold
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