HomeMy WebLinkAboutRuthinoski `,1.�
*.,' Town Hall, 53095 Main Road
_`04, �.®� • P.O. Box 1179
1 �,.' Southold, New York 11971
JUDITH T.TERRY
-----...,,lis'-' FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1510-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RUTHINOSKI, STANLEY AND ALICE
Mailing Address 1 P. O. BOX 383
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 220 OAK STREET
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8128
Tax Map No. section 141 .00 block 1 lot 14.000
Cross Street HORTON AVENUE
Date Of Last Pump Out 0/00/00
Aejalerneot
Issue Date: 7/31/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
N,/
. ... •
OE ICPOF THE TOWN CLERK � IL-
Town of Southold Q eo = Application No. ./S-7°
Judith T. Terry, Town Clerk � _ G
j 1 $10.00 - Residential ,/".-
Town Hall, 53095 Main Road
P. O. Box 1179 eW ��
t';')
$25.00 - Non-Residential
Southold, New York 11971 eO� �`
Telephone 0( ,`a ,•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 18
DATE /, 70
'OWNER NAME: S1 NL•ey c AL/c,e oT4rivos/6
OWNER MAILING ADDRESS: f? ô, $OY 3 8- 3
1l),477-77-oet / 1\iAy, rtQ fl-
OWNER--PROPERTY ADDRESS! 20 ®4& Si"
4-777 to et- N/ /113-4--
OWNER
/13— —OWNER TELEPHONE NUMBER: 543 029f- /1
t a
TAX MAP NO. : Section j,/1_______Block / Lot
CROSS STREET: �,/t/' s'%%
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: Ja.re.. /3 /q ft,
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.)
Signature of Applicant
RECEIVED BY: ,�,215
vuiVirriwClerk's Office
DATE: JUL 31 "%ki
Ion Cloud Sou
0 CieSS6
4
4
V
, a
14° tit rt
6
Q. g4 R, ��iffosk;
, ,I,:(A
21_0 c,,,,,, 6.T.
. ,
AIR-Tr/fa e-edi,y0,52-
74x M p ig-i=/�
J