HomeMy WebLinkAboutMajeski OFFICE OF THE TOWN CLERK
O"4 9
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 16' Residential X
Fee $ 10 . 00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Frank Majeski
OWNER MAILING ADDRESS: New Suffolk Lane
New Suffolk, NY 11956
OWNER PROPERTY ADDRESS: Corner of Fourth and King Street
New Suffolk, NY 11956
OWNER TELEPHONE NUMBER: 734-6885
TAX MAP NO. : Section 117 Block 7 Lot 8
CROSS STREET: King Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 24, 1986
Judith T. Terr
Southold Town Clerk
DATE: August 18, 1986 -
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 4`FFO _ .
Town of Southold o�� C��'; Application No. ��
Judith T. Terry, Town Clerk ` -. ,,-. _ �+�'
Town Hall, 53095 Main Road ;; ,G Residential
P. O. Box 1179 5 ��.,--‘.; 'v ` :'A Non-Residential
Southold, New York 11971 O ®j • '$Telephone *®.( �# "
,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
fo'r
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /S
Fee $ / 9
DATE 1 fi` _ 7I,
OWNER NAME: Fs p-1 t) V --1-6- g 1K' 0
OWNER MAILING ADDRESS: A (... IA) S 0 r F p L v. c__ 4 1ki 6
N 14l `c0 (- roil/> 1ii/,1.. if `l c'
OWNER PROPERTY ADDRESS: U Z4 nom,,—,Q .1° --+z , 0 ,` -
ii„,e}--,) ,J ,,e+,..e,-,, /,,,,, v f
OWNER TELEPHONE NUMBER: q 3_ L/ t t 1 3
TAX MAP NO. : Section 7 d 7 Block -7 Lot D
CROSS STREET: `- ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool L New Existing 4/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1 — 3-' `7 r
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.)
4 A.--is,-,ve— lik---1/4._1 ; r.
Signature of Appli t
RECEIVED BY: c�„_._
Town Crk's Of ice
DATE:___ /t /FA
0"V•C
=1
G UA
f .
fse...(4r-
P900‘56
70.2 P D a '— 5