HomeMy WebLinkAboutMajeski (2) pll
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JUDITH T.TERRY ' s �,,.' 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. 855-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MAJESKI, FRANK
Mailing Address 1 NEW SUFFOLK LANE
Mailing Address 2
• City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 NEW SUFFOLK LANE
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-734-6885
Tax Map No. section 110.00 block 8 lot 28. 001
Cross Street WICKS ROAD
Date Of Last Pump Out 6/00/85
Issue Date: 9/22/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK \\FFO
Town of Southold
-. , cot. Application No. ��-
Judith T. Terry, Town Clerk
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Town Hall, 53095 Main Road � ��F , �� ..G Residential
P. O. Box 1179cn ' "f' `
�,-. ����« moi ; Non-Residential
Southold, New York 11971 Of®
Telephone _0j ��
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE V? y Tr.
OWNER NAME: rtk j4 J A ,1 S Ic 1
OWNER MAILING ADDRESS: N C 6' ti F 1- 0 L V L
/J 14) S U F F o L- (, iv,/. j , c
OWNER PROPERTY ADDRESS: S /} M
OWNER TELEPHONE NUMBER: 1 3 c--/
TAX MAP NO. : Section f / D Block Lot
CROSS STREET: Lief 1 C /i S 0 .
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /t/ [ t q l
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.)
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Signature of Applicant,''
RECEIVED BY:
Town Clerk's Office
DATE:
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