HomeMy WebLinkAboutKurkostas OFFICE OF THE TOWN CLERK c ,`fa,',
Town of Southold
Judith T. Terry, Town Clerk O; �^-`
Town Hail, 53095 Main Road �' ` `
o ��
P. O. Box 1179 • 'S'
Southold, New York 11971 Q;'` .- _ �-
Telephone 00.E `1'�
(516) 765-1801 r
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 582 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Gus and Julie Kurkostas
OWNER MAILING ADDRESS: 3003 72nd Street
Jackson Heights, New York 11370
OWNER PROPERTY ADDRESS: Main Road
Orient, New York
OWNER TELEPHONE NUMBER: 718-424-0027
TAX MAP NO. : Section 21 Block 4 Lot 3
CROSS STREET: Narrow River Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
t--
Judith T. Tet '
Southold Town Clerk
DATE: January 26, 1988
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •i�1FOUrL"
Town of Southold ��y.ANN
CQ Application No.L5
Judith T. Terry, Town Clerk Town Hall, 53095 Main Road - Residential
� fir•
P. -0. Box 1179 w � : Non-Residential
Southold, .c1.414--'4 •
New York 11971 O ��
Telephone .1 11% •
- (516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE /�" 7' rif
OWNER NAME: - 37 : /7-4'
OWNER MAILING ADDRESS: � � �7
OWNER PROPERTY ADDRESS :fie; ,, ,--g ' r `;' Z,$7 , ,ef,e,;',y7—eP ��
OWNER TELEPHONE NUMBER: , °®"zyie-- `TQC
TAX MAP NO. : Sectio 2/ Block Lot
CROSS STREET: iie!pJ /10
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.)
' Signatur- •
RECEIVED BY:
Town Clerk's Office
DATE: