HomeMy WebLinkAboutLesica 1
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tE Town Hall, 53095 Main Road
1v ,i P.O. Box 1179
Vol of $�®=� 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. 3571-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner LESICA, DIANA AND JOHN
Mailing Address 1 P. O. BOX 1657
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 275 MAIER PLACE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2342
Tax Map No. section 55.00 block 6 lot 24.000
Cross Street BOISSEAU AVENUE
Issue Date: 1/14/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cOFO(x
Town of Southold CQG=� Application No3 S- 7(
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 8 ts: ; $10.00 - Residential t'
P. 0. Box 11790 '< ` �
Telephone � $25.00 - Non-Residential
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Southold, New York 11971 O` s '' k'=
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /d; d�
DATE \, I •.
1 •
OWNER NAME: e-1-‘ 0,w ek, er
OWNER MAILING ADDRESS: 0 .0 . CyIL51
SO kitioto &> �' � l Q1
OWNER PROPERTY ADDRESS: cl "_ c rnQ e 12. o:,c
OWNER TELEPHONE NUMBER: 1 (QS"-- P.'")qa
TAX MAP NO. : Section Lf5 Block • (O Lot l
TYPE OF SYSTEM: Septic,;Tank .: : �. New Existing
Cesspool ✓ New -Existing
Residential Non-Residential
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 f Applicant
RECEIVED BY:
Town;,C .k's Office •. .
DATE: /
RECEIVED
JAN 13 1997
Southold Town Clerk
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