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Home My WebLink AboutKujawski �%FOOL*'% st, 1. JUDITH T. TERRY ��1 0' �� Town Hall, 53095 Main Road P.O. Box 1179 TOWN CLERK REGISTRAR OF VITAL STATISTICS : v TGrS Southold, New York 11971 MARRIAGE OFFICER Fax (516) 765-1823 ;SVA. .sV Telephone (516) 765-1801 _ 1 ,$ OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1703-R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool New Existing X Name Of Owner KUJAWSKI, BARBARA Mailing Address 1 P. O. BOX 113 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 175 SOUND AVENUE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-4439 Tax Map No. section 120.00 block 1 lot 2.002 Cross Street ALDRICH, LANE Date Of Last Pump Out 0/00/00 Issue Date: 6/04/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK c�vFFD(,( ` Town of Southold /Q C� Application No. 263 Judith T. Terry, Town Clerk P-T, ,;;i ' '' y .r Town Hall, 53095 Main Road `= $10.00 - Residential p. O. Box 1179 cry $25.00 - Non-Residential Southold, New York 11971 Telephone 01_Jj #'.. (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE \**-i IS.4•1 3k n,9/1 OWNER NAME: \<7�-Cc'PcC. -i OWNER MAILING ADDRESS: Q,© . «3 i . 1 . OWNER PROPERTY ADDRESS: `'7 �c�vfi%ano -r Cc-� tV OWNER TELEPHONE NUMBER: 29,g - (4,4, S TAX MAP NO. : Section 1,20 Block Lot 2. 2.., CROSS STREET: TYPE OF SYSTEM: Septic Tank \/' New Existing v 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.) -40 Signature irplicant RECEIVED ,BY: Town Clerk's Office • - DATE: JUN 114 1991 tom _:,. ewe • . , ....1=WiMM=S11. • . ; -a•• • 49 • • • . , • -. ,,.•.---;,-L - • , . . , . , • ' . • , , . . . , , . • If.1 , ,..-, , . , 3 .......... 00, .. ., • v • ' . •. - , , • .. , • , -3(• ' . , , 0 . • _, .. , 16) /.;--: Jo • 61 Xx ,--,9 •••/•• a ... , _ .. , . • '0 - (11 . 1eekat _. e , - C)0 c,c ..* . M•26 v•a. ....4.9% ... - F . • , . . _. - 0( % ' •:) 5' f., • -3; C-... . ... , , .\...- & • .. 0.0-41-- if•ia,-41,1' .. q.,..- 1/4.06 . . -1,2 . . . ... . , . •cp . ..-, , •, -, r- 0 f,• • , C•. \ - , 0.5- ,-'• . c_.... . . vica. , „ , • . , , ,.. , •-,.. - . , , . - -7 ,- ‘0-- ,,ce,14. .---_ 14:• 1% . . C13 . , - , •, .... . . , • ' .4• - . •* • jil ' -• - 4.: - ts • Sq.fl. ,- • 11101111 . -4/1 4 _ . _ .a#1" ...I. a. 0. ,,,,,,•.g_s_..J•6_...g.f.:2'-- . t4r.g . . 1 • *.... , .04,r11 • . J. • ,i- i.•-"; k k t ' •..... , \cl- --- .• • - _ . ._ .• : ."e' I 404. ei• 01 l', 0.1‘ a. ° . 6+4 •" ... •• . , I 1°. 1 • , ,. . i • I :1A''', '.- ' . , -"•- , . - I I 14 ‘t.': -.. •... I t It CZ) , V•\ ... s•-- I . .:1*. , • I ' I- I • •• , . , , ' 99F ... . . 14% • ' . —ClIkL.'- ...- . iI I .--tr• • „ •••••''.." . - --.... - = /95:18 , • ,: •Ae 0 0 WI* slle50j17°.I W. . . ' ,ot. 4.82 . , . AVENUE • 50tiND . . . . , . . . , , . , . . . 'NOTE: , . . , . , . , _ . . ._, •RIIVIS114 45 § '1.- YO-UN,G,'.4 .-YI4P rOV ,._ - _ 1 2;'.;• . _ 400 ne.tnArtrIrn AlsrAiiiv, 1111,1frournam .4..4.. .....,,,....