HomeMy WebLinkAboutNorth Fork Animal Hospital OFFICE OF THE TOWN CLERK + 11.7. ,��
Town of Southold
Judith T. Terry, Town Clerk , J
Town Hall, 53095 Main Road B pro tt ; + '�
P. 0. Box 1179 3 zra ��1," *J ,`�f
Southold, New York 11971 s ,n,E �
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Telephone — ®.� 1 l,,ri
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR46 Residential
Fee $ 25.00 Non-Residential X
Septic Cesspool x
NAME OF OWNER: William E. Zitek, DVM - North Fork Animal Hospital
OWNER MAILING ADDRESS: Main Road
Southold, New York 11971
OWNER PROPERTY ADDRESS:Main Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2400
TAX MAP NO. : Section 56 Block 2 _ Lot 2
CROSS STREET: Laurel Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: May 1987
Judith T. Terry
Southold Town Clerk
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DATE: July 29, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK COFOCA-
Town of Southold ��� CS ' Application No.
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Judith T. Terry, Town Clerk }
Town Hall, 53095 Main Road'. ; `i :G Residential `
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P. O. Box 1179 �� ��� '�$�' Non-Residential
Southold, New York 11971 OSA® °"yF ',"
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- -- -- for - - - -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ c›?5
DATE 7/21r7
OWNER NAME: iititif/�0'�t.X rn$.L Asp/r/3-L_ *atom 1, Zt rK
OWNER MAILING ADDRESS: fJ#,/J
. STN o /�• . /1q71
OWNER PROPERTY ADDRESS: -
OWNER TELEPHONE NUMBER: 76�'z40
TAX MAP NO. : Section 3713lock -R. Lot
CROSS STREET: i'(eir D F ,(,1,�(tirLl.L, 41/f. 0/11 £C I . Zf Alkerid
TYPE OF SYSTEM: Septic Tank New Existing
/
Cesspools I/ New Existing V
Residential Non-Residential V
DATE OF PREVIOUS PUMP-OUT: 411 J�
.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.)
Signature f Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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