HomeMy WebLinkAboutKrupski (3) �o
Town Hall, 53095 Main Road-
P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY mss' FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1326-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KRUPSKI, JOHN
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Mailing Address 1 BOX 397
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Mailing Address 2 DEPOT LANE
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City St Zip CUTCHOGUE NY 11935-0000
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Property Address 1 DEPOT LANE
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Property Address 2
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City St Zip CUTCHOGUE NY 11935-0000
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Owner Telephone No. 516-734-6046
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Tax Map No. section 95 block ' 2 lot 1,1
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Cross Street OREGON ROAD
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Date Of Last Pump Out 1/01/85
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Issue Date: 11/30/89 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK
Town of Southold - Application No. X.3
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Judith T. Terry, Town Clerk $ ,
Town Hall, 53095 Main Road _ �t . 00 Residential L/
P. 0. Box 1179 cn $25.00 - Non-Residential
Southold, New York 11971 O
TelephoneOj
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.._A_3.2_4�
Fee $
DATE (�Z
OWNER NAME: V
OWNER MAILING DDRESS:
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: Z,..2
y TAX MAP NO. : Section Block Lot '
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ew Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
Sig -'ature of Applicant
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RECEIVED BY: 176mz�C71W6,
own lerk's.office
DATE: -
NOV 3 01989
rom Clerk southpm
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