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Home My WebLink AboutGrzesik 14"CAFEeir • . , Town Hall, 53095 Main Road V . o��, P.O. Box 1179 `N� -0 Southold, New York 11971 JUDITH T. TERRY ��/'i°°I TELEPHONE TOWN CLERK (516)765-1801 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. 1068-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner GRZESIK, STEFAN AND NORMA Mailing Address 1 RR 1, BOX 62265 Mailing Address 2 City St Zip GREENPORT NY 11944-0000 Property Address 1 309 NORTH ROAD Property Address 2 City St Zip GREENPORT NY 11944-0000 Owner Telephone No. 516-477-1486 Tax Map No. section 40.00 block 1 lot 4.000 Cross Street CHAPEL LANE Date Of Last Pump Out 0/00/00 - Issue Date: 3/31/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK •• FUTA' Town of Southold ��ry . CO Application No. f �d Judith T. Terry, Town Clerk . ,;f%;: " ` Town Hall, 53095 Main Road f : Residential P. O. Box 1179 v' ==Y moi ; Non-Residential Southold, New York 11971Oho _ �0��` Telephone - 1 4 1 • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE 3• OWNER NAME: 5 + Yb r R ,E OWNER MAILING ADDRESS: R. R. 1 eoX OWNER PROPERTY ADDRESS: 35 9 4RT /Pp : Ar,/ /s/ ?14 OWNER TELEPHONE NUMBER: 7 7 — TAX —TAX MAP NO. : Section Block / Lot V CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing X Residential \14, Non-Residential DATE OF PREVIOUS PUMP-OUT: 41,4,47. - LOCATION 1,4JLOCATION 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 A icant RECEIVED -3 Town Clerk's Office DATE: MAR 31 1989 4 ,, I, . . .. . .., • . . , . . . _ . . . . ., , . •., . ,_ . , , , , . ... . . , • ......... _ , , . . . . . , _..... .. . , . , . . . . , . ,. , . . . ... . , .. . ... . ... . . . . ... . . . .. . . • . . . , :,., ... : ,_ , . . .. . . . , . . .. . . . , ,, . , ,.. ... , _ _ , . . , . . , ,,... . . .. , • ,...4 , . _....... ...__,..__..... .._____„_______,.............._ ,....„.._ ____77_......„... , 4 , . . , „ _ ., . „ , ,. , . . . . ... . , . ,,,,r - ,.. . , _. ,, ,, - _ . ,- , . . . . , • ., , . . . , . . - ., . . , it) I . gilf. : , 1 , . --1---; 4,..,/:(1- (7),_1_c_ . , ki ,---.<0.....(,\ ., . ..., ,. . ,., . .. . . . .. , y t, L___=________L_ . . . „ _ I I .. - ! • . . — , ,, . f i. ..,,, , , 6,- 6 ' / . _ ' . - . • ,.... . . . . . . . . . , . . • .... . . . . . . . . .. . , . . . . . . . . . .. . ., „.