HomeMy WebLinkAboutKlavas OFFICE OF THE TOWN CLERK • FQ i��
_ Town of Southold ����w—
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Judith T. Terry, Town Clerk ;� . . `-
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Town Hall, 53095 Main Road c N
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P. O. Box 1179 ', cntis4C3 '`
Southold, New York 11971
Telephone
(516) 765-.1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT _
SEPTIC TANK or CESSPOOL
Operation Permit No. 457 Residential x
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Gus and Angela Klavas
OWNER MAILING ADDRESS: 166-07 14th Road
Beechhurst, New York 11357
OWNER PROPERTY ADDRESS: Beixedon Estates, Ashamamoque Avenue
Southold, New York 11971
OWNER TELEPHONE NUMBER:- Home: 718-746-9370 or Business: 718-846-2420
TAX MAP NO. : Section 66 Block 3 Lot 6
CROSS STREET: Orchard Road
TYPE OF SYSTEM: Septic Tank New Existing
' Cesspool X± New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. ler' y
Southold Town Clerk
DATE: October 9, 19877
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK JJU //�
Town of Southold ��o : _. LQG Application No.`7� 7
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road o � x :' Residential
P. 0. Box 1179 v' :' Non-Residential
Southold, New York 11971 O ®sigs. " '
Telephone o.( } 0
(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 69
DATE 4,-91 /4- J
•
OWNER NAME: 6 a,g , (C'knot-s
OWNER MAILING ADDRESS: /“— 67 t-ce ie_o-a,.c1
g eec A 11 I , b
OWNER PROPERTY ADDRESS : ec hrec-41. Ls F. cLtc( vkla c-ne-rt
OWNER TELEPHONE NUMBER: #01410G-E”) 7 ccG— ?37O ; (7a) ftIGrZy Zo
TAX MAP NO. : Section 6 6 Block '3 Lot Z
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: //9,7
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.)
aL� " /
ign7 ure of Applicant
RECEIVED BY41%,,,L,o/
E `i o ir ) lerk's ice
DATE: T 0 0 inT
posthold Town Work
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