HomeMy WebLinkAboutGaydos OFFICE OF THE TOWN CLERK ' c0FD(/(
Town of Southold �%: C
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Judith T. Terry, Town Clerk "=
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Town Hall, 53095 Main Road
P. 0. Box 1179 �• �,�
Southold, New York 11971 ,
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 5 Residential ,XXX
Non-Residential
Fee $ _ 10 . 00 '
Septic XXX Cesspool
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NAME OF OWNER: Paul Jon Gaydos
OWNER MAILING ADDRESS: 1098 Wickham Avenue, P .Q . Rnn4
Mattituck, New York 11957
OWNER PROPERTY ADDRESS: same
OWNER TELEPHONE NUMBER: 298-5386
TAX MAP NO. : Section, -" _ _ Block 1 Lot 4
CROSS STREET: Route 48
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XXX New Existing XXX
Residential XXX Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7/10186
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Southold Town CI rk
DATE: August 15 , 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �cwFFO(.,(-e:�
Town of Southold ®moo y COG', Application No. .j
Judith T. Terry, Town Clerk . k ,� fi,
Town Hall, 53095 Main Road c `'o "''', Residential l�
P. O. Box 1179 - ;, „t'': �.`' Non-Residential
Southold, New York 11971 O � r- . *��`
Telephone e t ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ / 0, O a
DATE de—/ 3- rico
OWNER NAME: A.../L.. �D"✓ I ' / ®0S
OWNER MAILING ADDRESS: /0,17 6)e.c-iC 44,,..1 ,ieb.,e— '42137)1
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OWNER PROPERTY ADDRESS: //-2^r-E--G1--
OWNER TELEPHONE NUMBER: C2-1i 3tr(f,
TAX MAP NO. : Section ./_40 Block I Lot
CROSS STREET: X-7 . Y(
TYPE OF SYSTEM: Septic Tank New Existing �'
Cesspool t/ New Existing
Residential ti-------- Non-Residential
DATE OF PREVIOUS PUMP-OUT: L t to m+/ -'.?C
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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RECEIVED BY: , // ,I, /..,/.
T.wn ( ler s Office
DATE: cFP /
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