HomeMy WebLinkAboutGrabowski ' �jp it ..
. , _ Town Hall, 53095 Main Road
ts' ' P.O. Box 1179
`07 Southold, New York 11971
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JUDITH T.TERRY - ®� � f�,,,0 0 TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OI VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
• SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 893-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GRABOWSKI, VICTORIA
Mailing Address 1 132 PEQUASH AVENUE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 132 PEQUASH AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6594
Tax Map No. section 103.00 block 11 lot 11 .000
Cross Street WILLOW STREET
Date Of Last Pump Out 0/00/00
Issue Date: , 11/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cOFDU(�'= �3
Town of Southold `-, Deo . re ‘, Application No.
Judith T. Terry, Town Clerk . 'Y �
,-17',72s.� :• ..G ) Residential
Town Hall, 53095 Main Road
'P: O. Box 1179 v» ,' Non-Residential
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Southold, New York 11971 O ;4,147=
Telephone _ .('41 ft • •�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RE. APPLICATION
OCT 8 1988 for
Um MR `Sohl OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /• ��'
DATE1,4)1.
) /1
OWNER NAME: C,�-f1��/� /en,tg 0 S-�C'/
OWNER MAILING ADDRESS:/ Pf` ` j,�4-5 /44. Acia
C. 1-C.1146" u, /V7
OWNER PROPERTY ADDRESS:_/-' 2_ . _ „ot) ,q
OWNER TELEPHONE NUMBER: 2 3y
TAX MAP NO. : Section /e," Block /1 Lot ((
CROSS STREET: ki) jL,L40 6 /
TYPE OF SYSTEM: Septic Tank `/ New Existing
Cesspool New Existing
Residential Il - Non-Residential
DATE OF PREVIOUS PUMP-OUT: fI P/? Lam. /911
LOCATION MAP: Must be attached, hereto before permit may be issued.
(Locate building and system; gives north arrow and feet
of distance, approximately, to building and closest road.) _ _
j_cz:L/tylet) 4e, i r
Signature of ' pplicant
RECEIVED•,BY::
Town Clerk's Office -
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DATE:
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