HomeMy WebLinkAboutKrupski (7) T.
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Town Hall, 53095 Main Road
P.O. Box 1179
y Southold, New York 11971
JUDITH T.TERRY ®°� TELEPHONE
TOWN CLERK (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. 939-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KRUPSKI, WALTER
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Mailing Address 1 7750 BRIDGE LANE
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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 7750 BRIDGE LANE
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Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
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Owner Telephone No. 516-734-6115
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Tax Map No. section 84.00 block 2 lot 1 .001
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Cross Street COUNTY ROUTE 48
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Date Of Last Pump Out 0/00/00
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Issue Date: 11/30/88 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c,�FF0
Town of Southold ��� CQG Application No. / 3
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road -< 7 Residential
a-
P. 0. Box 1179 u' Non-Residential
Southold, New York 11971 O
Telephone.(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: Fsk, (10 cu)h 2_'J_
OWNER MAILING ADDRESS: 77Y,
Cu 11
OWNER PROPERTY ADDRESS: Sg 3-nc
OWNER TELEPHONE NUMBER:
7 v2
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New 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.)
Signa ur f Applicant
RECEIVED BY:
Town lerk's Office
DATE:
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