HomeMy WebLinkAboutMarczewski OFFICE OF THE TOWN CLERK ' FuLA-1,
Town of Southold
Judith T. Terry, Town Clerk s. Y 4
Town Hall, 53095 Main Road ' -5.
P. O. Box 1179 'A c�n
Southold, New York 11971
Telephone - j
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 517 Residential 'X
Non-Residential
Fee $ 10.00
Septic Cesspool y
NAME OF OWNER: Walter Marczewski
OWNER MAILING ADDRESS: 203 Knapp Place
Greenport, New York 11944
OWNER PROPERTY ADDRESS: 203 Knapp Place
•
Greenport, New YOrk
OWNER TELEPHONE NUMBER: 516-477-0925
TAX MAP NO. : Section 34 - Block 3 Lot- 14
CROSS STREET: Bailey Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
•
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. T y
Southold Town Clerk
DATE: December 3, 1987
(TOWN SEAL)_
OFFICE OF THE TOWN CLERK OFD
Town of Southold , ��� t
; rem', Application No 677
Judith T. Terry, Town Clerk
� _ r•C Residential 4/
Town Hall, 53095 Main Road 8 P. 0. Box 1179 crs # t ' • Non-Residential
Southold, New York 11971 O •_ ti= •�`
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /O
DATE
OWNER NAME: i0(2117162 4a'e z ea.)54.
OWNER MAILING ADDRESS: 203 7/1 o5 P) 71cI
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: V77— 0CIo25
TAX MAP NO. \ Section 3 Y Block 3 Lot //
CROSS STREET: f�/ C�)-PiwLC-e-
d
TYPE OF SYSTEM: Septic Tank X New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /6 - /6
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.)
Signaturedef Applicant
•
RECEIVED BY: d
Town C rk's Off e
RECEIVED
DATE:
3nivr CWit Southold
oNk
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