HomeMy WebLinkAboutRutkoski � O
JUDITH T.TERRYk�� OG'L03 Town Hall, 53095 Main Road
TOWN CLERK ` ® 1 P.O. Box 1179
vs =
REGISTRAR OF VITAL STATISTICS ; rftt Southold,New York 11971
MARRIAGE OFFICER "#4°
Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER `_ ® .��® $ Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER - ���'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3638-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner RUTKOSKI, IRENE
Mailing Address 1 P. O. BOX 381
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1560 VANSTON ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-298-8037
Tax Map No. section 111 .00 block 4 lot 10.000
Cross Street HAYWATERS ROAD
Issue Date: 5/22/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
=114 !I/'
OFFICE OF THE TOWN CLERK cvFFEU -
Town of Southold �� , CQA Application No. 6
Judith T. Terry, Town Clerk �� .�` , ,
Town Hall, 53095 Main Road s'', �G 1 $10.00 - Residential
P. O. Box 1179 cr3 ` ;` $25.00 - Non-Residential
Southold, New York 11971 � '® x., *r$
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE May 20, 1997
•
OWNER NAME: Irene Rutkoski
OWNER MAILING ADDRESS: PO Box 381 ,
Mattituck, New York 11952
OWNER PROPERTY ADDRESS : 1560 Vanston Road
Cutchogue ® New York 11935
OWNER TELEPHONE NUMBER: 516-298-8037
TAX MAP NO. : Section 111. Block -4 Lot -10
473889
CROSS STREET: Haywaters Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing K
Residential x Non-Residential
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.)
Sigr a'ture of Applicant
RECEIVED BY:
Town Clerks Office
DATE: g/ (97
k
414
./r,
•
•
•