HomeMy WebLinkAboutFaszcezewski •
•
OFFICE OF THE TOWN CLERK ��FV[ �,
Town of Southold � •
Judith T. Terry, Town Clerk � 4.-�
Town Hall, 53095 Main Road r - ' ` '
P. O. Box 1179 (11 t �
Southold, New York 11971 "Yy •
Telephone � _ �1^ •
(516) 765-1801
TOWN OF SOUTHOLD .
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 550 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Edward Faszcezewski and wife
OWNER MAILING ADDRESS: Gagens Landing
Southold, New York 11971
OWNER PROPERTY ADDRESS: Gagens Landing
Southold, New York
OWNER TELEPHONE NUMBER: Unlisted
TAX MAP NO. : Section 70 Block 10 Lot 33
CROSS STREET: South Street
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 ry
Southold Town Clerk
DATE: December 28. 1987
(TOWN ,SEAL)",
i _
OFFICE OF THE TOWN CLERK .COFour -
._ ,S-°
Town of Southold s�� =F-� . Application No
Judith T. Terry, Town Clerk `'I Residential
Town Hall, 53095 Main Road o , :
P. O. Box 1179 C� ; t` • Non-Residential
Southold, New York 11971 O ®
Telephone : .( y ' '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No:-47-5-0
Fee $
DATE /L/-t5/0E-7
/
OWNER NAME g&,2-P e.-_�� `�' / 4-'
f /
OWNER MAILING ADDRESS:
// 7/
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section '7 6 Block /v Lot
CROSS STREET: czces2-.--e-7 c4- ~
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
- DATE OF PREVIOUS PUMP-OUT:
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 of Apr, c..•f'
RECEIVED BY
ToWn Clerk' Office
DATE: /7ef�
Z �
� w I
D
\k