HomeMy WebLinkAboutFedynak 44,tf ULiret
Town Hall, 53095 Main Road
P.O. Box 1179
�� �� ����� Southold, New York 11971
JUDITH T.TERRY _ FAX(516)765
TELEPHONE(516)765 765-1801
TOWN CLERK
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. 1336-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner FEDYNAK, RAYMOND E. AND WIFE
Mailing Address 1 2337 WEBSTER STREET
Mailing Address 2
City St Zip NORTH BELLMORE NY 11710-0000
Property Address 1 FAYE COURT
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-718-9596
Tax Map No. section 123.00 block 5 lot 16.000
Cross Street CAMP MINEOLA ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 12/06/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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of a+r
OFFICE OF THE TOWN CLERK c3\\FFO(,r
Town of Southold > CSG•, Application No. / 3-5k
Judith T. Terry, Town Clerk ‘ �';".�s' ' , y
Town Hall, 53095 Main Road Ki,= $10.00 - Residential
P. O. Box 1179 4 $25.00 - Non-Residential
Southold, New York 11971es
Telephone _Ol `•S
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT •
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 1\IN 30 al
OWNER NAME: I`A'f M,WP FeMUArk, * t() ' •
OWNER MAILING ADDRESS: '2_5$1
X271 ( 13[u_pi10 12.6 1 A) Hitt,
OWNER PROPERTY ADDRESS: .F !✓ C - - -_
►M IrlrUcK , iMY 11RS'a
OWNER TELEPHONE NUMBER: 7l0 '7?-1,13o ✓��J �—� �'
TAX MAP NO. : Section 3 Block 5- Lot lL
CROSS STREET: e(,,--ryike? int/.e ' ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X 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.) _ _
/
ignature of Appfcant
RECEIVED BY:
Town Clerk's Office
DATE:
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