HomeMy WebLinkAboutKrupski (6) Town Hall, 53095 Main Road
ems® P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY 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. 1110-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KRUPSKI, VINCENT
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Mailing Address 1 9385 OREGON ROAD
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Mailing Address 2
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City St Zip CUTCHOGUE NY 11935-0000
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Property Address 1 9385 OREGON ROAD
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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. 516-734-6580
Tax Map No. section 95.00 block 1 lot 20.000
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Cross Street DUCK POND ROAD is DEPOT LANE
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Date Of Last Pump Out 9/20/79
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Issue Date: 5/15/89 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
.r
OFFICE OF THE TOWN CLERK SVFF�(,(� '
Town of Southold 0�� CQG Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road, -� Residential
P. 0. Box 1179 v' Non-Residential
Southold, New York 11971 O
Telephone OjIrk
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
MAY 15 1969 OPERATION PERMIT
1011 04 NOW SEPTIC TANK or CESSPOOL
Operation Permit No.__&Z.D. .
Fee $
DATE
OWNER NAME: ( ,i/c- n/-T
KL up s K r
OWNER MAILING ADDRESS: q-3 SX' 0 rCoA/ �d
�'. Lj-eJ,0&0c;0 AL �l. 1113.'
OWNER PROPERTY ADDRESS: AS , /n b ® U�'_
OWNER TELEPHONE NUMBER: "'/�
TAX MAP NO. : Section Block Lot
CROSS STREET: (Ore-Gov Rd P&jpg7•'4a4e , A-rag Po/wd Rd
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 3 New Existing
Residential j/' 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.)
P
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
MW
DATE:
— MAY 15 1989
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