HomeMy WebLinkAboutLajda OFFICE OF THE TOWN CLERKOU((`+�
Town of Southold O�
Judith T. Terry, Town Clerk , _-
Town Hall, 53095 Main Road ff`
P. 0. Box 1179 v� K
Southold, New York 11971 � � ` ' !�
Telephone 70 41 1R
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 394 Residential X
Fee $ 10.00'.' Non-Residential
Septic Cesspool X
NAME OF OWNER: Ronald and Lydia Lajda
OWNER MAILING' ADDRESS: 600 Eastwood Drive, Box 219
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 600 Eastwood Drive
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-5897
TAX MAP NO. : Section 103 Block 14 Lot 11
CROSS STREET: North Cross Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 1987
Judith T. Terry`
Southold Town Clerk
DATE: August 11, 1987
_ . y(TOWN SEAL)
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OFFICE OF THE TOWN CLERK , �FF� � -
Town of Southold ���� Application No. 3 9y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road a ' -0414Als
Residential
P. O. Box 1179 En ‘ fisg' moi :, Non-Residential
Southold, New York 11971 ��`
Telephone =40A--Ore,
(516) 765-1801
.. TOWN OF SOUTHOLD
AUG 0 7 1987 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town C►erk Southold
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE ay /977
OWNER NAME: v ` u ,41,9'L,e) 41(eY/9
OWNER MAILING ADDRESS: eco 8d2, ® cA /f
�/TTi/�Ol(lam ,/��/?/ d,R /4,f
OWNER PROPERTY ADDRESS: 4640 i ea-eP
OWNER TELEPHONE- NUMBER: /?4- -1797
TAX MAP NO. : Section /13 Block / Lot //
CROSS STREET: /f DO ',W '/2d
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool (/ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 6" t2
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.)
ature of Applica
RECEIVED BY:
Town Clerk's Office
DATE:
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