HomeMy WebLinkAboutLikokas cOf
Town Hall, 53095 Main Road
) P.O. Box 1179
s� � Southold, New York 11971
Y
JUDITH T.TERRY _®j �s ,. TELEPHONE
FOWN 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. 829-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner LIKOKAS, ORESTIS
Mailing Address 1 88-23 RIDGE BLVD
Mailing Address 2
City St Zip BROOKLYN NY 11209-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 218-238-3151
Tax Map No. section 31. 00 block 3 lot 10. 000
Cross Street STARS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/14/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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Town Hall, 53095 Main Road
P.O. Box 1179
®r +� Southold, New York 11971
JUDITH T.TERRY = � °�6',0. 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. 830-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner LIKOKAS, ORESTIS
Mailing Address 1 88-23 RIDGE BLVD
Mailing Address 2
City St Zip BROOKLYN NY 11209-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 718-238-3151
Tax Map No. section 31. 00 block 3 lot 10.000
Cross Street STARS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/14/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
(6®6j
Ir cr4
Town Hall, 53095 Main Road
��`� P.O. Box 1179
_® toti°
i4 Southold, New York 11971
®�JUDITH T.TERRY ~=. TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR 01-VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 831-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner LIKOKAS, ORESTIS
Mailing Address ,1 88-23 RIDGE BLVD
Mailing Address 2
City St Zip BROOKLYN NY 11209-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 718-238-3151
Tax Map No. section 31. 00 block 3 lot 10. 000
Cross Street STARS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/14/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
to �� � '
OFFICE OF THE TOWN CLERK g' 3 b
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Town of Southold % ;• `�e4'. --
, Application No. 3/
Judith T. Terry, Town Clerk ` + 6 h.G
Town Hall, 53095 Main Road . :�Y '-'4 r: 7 Residential
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P. O. Box 1179 to ":�� ram hzi ;• Non-Residential
v.Southold, New York 11971 O � Y0"°"
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Telephone = j
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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 $ lb.
•
DATE
OWNER NAME: 3,&74& 41/649
OWNER MAILING ADDRESS: ' gr--a3 / gevi
8e0off id, 0
OWNER PROPERTY ADDRESS: aidDail ,
OWNER TELEPHONE NUMBER n
dZ3r-3/S� Jo7-O 19� ,
rTAX MAP NO. : Section / Block `? ✓✓ Lot /(7
0
CROSS STREET: 6c c ,
TYPE OF SYSTEM: Septic Tank / New Existing
Cesspool V New Existing
Residential /��}} Non-Residential
9
DATE OF PREVIOUS PUMP-OUT: / '7 j 3
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.)
e4....4 7 L7----—,Tf/z;7-,....., .
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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