HomeMy WebLinkAboutSacks OFFICE OF THE TOWN CLERK , O[�Ir`,"
Town of Southold `
Judith T. Terry, Town Clerk 4'� ' `
Town Hall, 53095 Main Roadf
P. O. Box 1179 u) •
Southold, New York 11971 =Q �.�O�
Telephone ^ �,( j'[
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 181 , Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Gregory Sacks
OWNER MAILING ADDRESS: P.O. Box 990
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 1365 Donna Drive
Mattituck, New Yor k
OWNER TELEPHONE NUMBER: 516-298-4925
TAX MAP NO. : Section 115 Block 16 Lot 13
CROSS STREET: New Suffolk Avenue -
TYPE OF SYSTEM: Septic Tank X New Existing x
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: None
•
•
Judith T. Terry
Southold Town Clerk
DATE: December 16, 1986
•
r
(TOWN\ SEAL)
F i All Ili II
OFFICE OF THE TOWN CLERK
Town of Southold4 COG' Application No.
Judith T. Terry, Town Clerk �'' ',
L3" ) Residential
Town Hall 53095 Main Road ,r
P. O. Box 1179 cry "> ij ' Non-Residential
Southold, New York 11971 ,
Telephone
gyp.,,:
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 7?/
Fee $ c�s--
/O
DATE 102" c-
OWNER NAME: Cne-5Ury S QGIC3
OWNER MAILING ADDRESS: P%O• O�C �q�
Iia-,-h-tuck. , pry )1 s�
OWNER PROPERTY ADDRESS: l PCIAn Drq,r�
Ma-�htz�ck ivy.) 19 S2-
OWNER TELEPHONE NUMBER: 516- aIe.- /f.t.i
tUlSOrr
TAX MAP NO. : Section 115— Block Lot
CROSS STREET: NP W -ice -o
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential t7 Non-Residential
DATE OF PREVIOUS PUMP-OUT: WON/C.-
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.)
2val
Sign-4 re Applicant
RECEIVED BY: Is„d
RE'-1`t;"Town /erk's Office
DATE: DEP 1 6 "t
Town Clerk Southold
K ti
T i i
0 CD
---
512.121-IL
/ 0
C5'VL 4 D`r �'2,