HomeMy WebLinkAboutRutkoski OFFICE OF THE TOWN CLERK • 1C0f4`1D
Town of Southold
Judith T. Terry, Town Clerk ; f: t4"
Town Hall, 53095 Main Road a
P. O. Box 1179 to ' •:
Southold, New York 11971 k Q ®. `'_ Off- •�
Telephone ,( DtP-
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 154 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Henry Rutkoski
OWNER MAILING ADDRESS: Main Road
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Main Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4229
TAX MAP NO. : Section 115 Block 2 Lot 10
CROSS STREET: Cardinal Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 9, 1986
40.1%07..0
Judith T. Terry
Southold Town Clerk
DATE: November 19, 1986 •
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cgF�(�
Town of Southold CQ Application No. /5--yJudith T. Terry, Town Clerk Y {
Residential
Town Hall, 53095 Main Road .,,4 n -
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P. O. Box 1179 c ;' Non-Residential
Southold, New York 11971 4 tvi, e.<
Telephone _ ' tZt ‘tt.#'.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION .f
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. '-c /
Fee $ /6, 4r-
DATE / 11/e/e
OWNER NAME: 7-76;i1/� V r tco Sx
OWNER MAILING ADDRESS: ,M� fQ( x'7`7` / T'C9 e .CC'
OWNER PROPERTY ADDRESS: SA---3-/ e
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section / / Block a-- Lot JCS
CROSS STREET: C M". .o9,'v iqC P (J%
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing c.-----
Residential v-- Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7- 7-8',6
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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71-Q-'-c-c
Signature of nt
RECEIVED BY: , tc.4-
Town Qlerk's ffice
RECEVIID
DATE:
Town Clerk Southold
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