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Home My WebLink AboutGlowacki JUDITH T. TERRY +� Town Hall, 53095 Main Road „ p TOWN CLERK rg x 1 P.O. Box 1179 REGISTRAR OF VITAL STATISTICS ( x� Southold, New York 11971 MARRIAGE OFFICERv� �� Fax (516) 765-1823 �_-_®� .�,,0�' Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1641-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner GLOWACKI, CLARENCE & MILDRED Mailing Address 1 2020 MARLENE LANE Mailing Address 2 City St Zip MATTITUCK NY 11935-0000 Property Address 1 2020 MARLENE LANE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-4702 Tax Map No. section 144.00 block 2 lot 31 .000 Cross Street MAIN ROAD & PECONIC BAY BLVD. Date Of Last Pump Out 0/00/83 Issue Date: 3/14/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFF.kCE OF.THE TOWN CLERK .S\\FFO(,��'•__ / �� Town of Southold �� CQ Application No. Judith T. Terry, Town Clerk t $10.00 - Residential Town Hall, 53095 Main Road P. O. Box 1179 �' r� � $25.00 - Non-Residential Southold, New York 11971 Oclo ��''` Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION RICSEOVRD - — for n(� TOM OM OPERATION PERMIT '®°A*61/®1)44® p4 SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE # OWNER NAME: GLA/2f/jC A AND mlL43 r GCovi44 ' OWNER MAILING ADDRESS: .2.002.0 triA PIAVE LAtiii' /err fro H ' 1I9611 OWNER PROPERTY ADDRESS: .3 Q tviE OWNER TELEPHONE NUMBER: �q g - 1{70 a-- TAX MAP NO. : Section /V47 Block a Lot 3 1 CROSS STREET: /1TgJA/ RD XM9 Prcokeec. (3LAl1) TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: /e7-3 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.) 41111,) , r Signa ure of Applicant RECEIVED BY: ,%' rger , wn; `T'"'s Office DATE: L-,/1?-7:?/ . , - , . .....t- x • '-... . - - \. . . . _ . NIIIIIIMEREMPI _____ • • ? r., -..; ... • 0 --., -.., (., .:. ....• \..1-31 • -_, (-1 0 ..-1 x0- • ... os.. ., ._ . 63 .2-54 XO '.. • ., 0, --• 0 . • 41 •- • o 7:€_• .C• '''' 4-1- - . i..) •-•",, CD . _ • ' c. 2. • ,6•3 7: -.- .,...1 ...1 sii. a... ..- • 7''' . . *I _ - • ft"' ., 0) . .7.- . -• I 9f 4,;.5C ' : _ . . -WI /to''' 3,. Z - - ..... ,.0,,. tis: . 3 0 2 - , . --- -- . ii . .‘• _ -...-..f . (...) - (1) • . . i - • - -: _ ... 1, N......... 1 -- 4, ......r. - .- • .....''ii i ' -. • - 0 •1 "-----.'- , •,- '-: -' , , - -. - - , :.. CrS- -., -1,.. .'-- ' . •-• - ;- - • t• - _ . - . . , i..•: _-:. :.;- :-.1*-:`-•' -'" -- -- V) -- ' - / • __ . . '- - • -- * " . - 1...- .,.€.--..... . ...- •'.- , : o P ' . 11 - -- •:,',- . ::. - ' • ; ' - 1,0 '' ,,),C) ., .. _ 45 0 - 1 fe 1 . n o ., • - - . . . . cD - re•,k.% FAT ‘0 W - " e8 • •- • Z , • , . ., ,, - -_ - 41• " " . . _ - . - , ' - _--. :_,- -:-2- - • so° ,. c., _ tocrc'?(O.,YetV‘e-4, . . . -‘.; _..,.,• -: ' . -- . _. . •••CI 1 .' V\0%ii iD°V‘C _ .•' ' • CU ‘1% . ( - k i 1 1 . , , .