HomeMy WebLinkAboutKrupski •
JUDITH T. TERRY , ' _ Town Hall. 53095 Main Road
TOWN CLERK _+ _= c = P.O. BOX 1 179
REGISTRAR OF VITAL STATISTICS , =,
i -'• P;�; Southold, New York 11971
MARRIAGE OFFICER ;.?;;:a ',4 ',=-'f _ 1 Fax (516) 765-1823
..:d, Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1620-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KRUPSKI, WALTER J. JR.
Mailing Address 1 315 PAT LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 315 PAT LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8026
Tax Map No. section 114.00 block 10 lot 6.000
Cross Street DEER DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 1/17/91 Judith T. Terr
Southold Town Clerk
(TOWN SEAL)
Y /
/6 020
OFFICE (fF THE TOWN CLERK, \\FFO
�5 �C�
Town of Southold
Application No.,
Judith T. Terry, Town Clerk . ..rt k °» FX
Town Hall, 53095 Main Road 8 r4 $10.00 - Residential V�
P. O. Box 1179cr3t .,,..�. 'moi � $25.00 - Non-Residential
Southold, New York 11971 O ®
Telephone( `tt
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
a fit/M pr- GLIAS l b z 10
Fee $ /0. 0
DATE J.4141(104-7-44/ 3� l1?,
W14-c-OWNER NAME: Tom' J• l�l �$ l J2 . •
•
OWNER MAILING ADDRESS: -3 IC i 4r "
N n-rriCc! 0,5- -
OWNER PROPERTY ADDRESS:
51.°1"1/1'-cH
OWNER TELEPHONE NUMBER: C 57 ( di,: #02-4
l
TAX MAP NO. : Section / � Block /0 Lot 626
CROSS STREET: ,Cel. "1e' Of LV? /.144-/ /211'76 '0Pe jO2/a/e u 611-
TYPE
' 'TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 3< New Existing k
Residential x Non-Residential
U&tilt-0 .U4). .S i4-4 OceJAJ o T& t#o 4' e sYwc-e
DATE OF PREVIOUS PUMP-OUT: ,ivar-e ('776, Cesrpoo'- is Na; e.4.1
OJi tot/- /C Tt41 S f4.Rt®D
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.)
•-, ure of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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4 5"o 5-e C Wt t.Q,4 t Ccolec of this Tutvay mss not bearing Is
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to 133 a valid true copy. i t i r t,i t'ci s!C.e. owe Pa H it
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Guarantees indicated hereon ehofl YenCI 5 ''.-"i t'VC=€ `: t�t,4 YZ a.fir. 4'i 76.
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fending institution listed hereon end r 11*r� & '�� �, l
to the assigr:ees of the lending inti- it fir""l',
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1 ;mien Guarantees are not transferable . x
�` to ::.ons'•r,st;tutione or sukssgwnt != t" - -^4 l—C1 1 ti at.Y•1 L. t i