HomeMy WebLinkAboutKontowski 1��1�.00%
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gn • ., ;_ Town Hall, 53095 Main Road
®,�._ A=. P.O. Box 1179
Z 0' Southold, New York 11971
JUDITH T.TERRY ?%� ���� `� FAX(516)765-1823
TOWN CLERK TELEPHONE(516)7654801
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. 1482-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KONTOWSKI, THELMA I .
Mailing Address 1 P. O. BOX 54
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 9580 MAIN ROAD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-0934
Tax Map No. section 31.00 block 10 lot 3.000
Cross Street BAY AVENUE
Date Of Last Pump Out 0/00/84
Issue Date: 6/14/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cwFFD(,-
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Town of Southold ® C0 Application No. / V
Judith T. Terry, Town Clerk Z � +:
Town Hall, 53095 Main Road ~ .441 5+� -< ) $10.00 - Residential
P. 0. Box 1179 ('-3 r � i ; $25.00 - Non-Residential
Southold, New York 11971 us-O0
Telephone j * �►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
.OPERATION PERMIT
SEPTIC TANK or CESSPOOL
it
Operation Permit No. / 4'
Fee $ lO. "
DATE
•
OWNER NAME: %G%Ct/V /✓j7' •
•
OWNER MAILING ADDRESS: 9,r_kQ 7a,..0.) Xgeld
.Z 0,,4,6 J /193?
OWNER PROPERTY ADDRESS:
(5,tA,Z" '"))
OWNER TELEPHONE NUMBER: 6^/6 L/ Q 9 </‘
TAX MAP NO. : Section -7 Block 9' Lot
CROSS STREET: Bot, a.,7„.„2„
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing )(
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached hereto befog permit may be issued.
(Locate building and system; dive north arrow and feet
of distance, approximately, to building and closest road.)
"/ / , ,
Signatu e of Applicant
RECEIVED BY: i
Town Clerk's Office
DATE: V— 9
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