HomeMy WebLinkAboutSadowski OFFICE OF THE TOWN CLERK • FU
Town of Southold ����� C�y
Judith T. Terry, Town Clerk •% 1611,
Town Hall, 53095 Main Road
P. 0. Box 1179 % '71$
Southold, •
Southold, 'New York 11971 �Q �' , •
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_ Telephone ZIo,1 O ,�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT --
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 148 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
-- NAME OF OWNER: Stanely Sadowski
OWNER MAILING ADDRESS: P.O. Box 53
New Suffolk. New York 11956
OWNER PROPERTY ADDRESS: Orchard Street
New Suffolk. New York 11956
• OWNER TELEPHONE NUMBER: 215-734-6839
TAX MAP NO. : Section 117 Block 5 Lot 39
CROSS STREET: New Suffolk Road -
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing y
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: September 3, 1986
100 •
14111;e9
Judith T. Ter
Southold Town Clerk
DATE: NOvember 14, 1986
(TOWN) SEAL)
II A.r-
OFFICE OF THE TOWN CLERK SVFFair - �/
Town of Southold % �` CQG Application No. /7(�"
Judith T. Terry, Town Clerk . , �►�
. yr;�. ��I Residential
Town Hall, 53095 Main Road a R=:.P. O. Box 1179 cn -A004:46 ► Non-Residential
Southold, New York 11971 OA® '' Y �
Telephone , %� ��•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. / '/f
Fee $
DATE MoUEnt,3srz /1, 1986
OWNER NAME: L j 8mbowsgc1
OWNER MAILING ADDRESS: p, p, gox 53
Al cua g'uFPoc.rc, AI, Y.) 1196-6
OWNER PROPERTY ADDRESS: OQeumzr S'rp&6"7'
/Ucw 5u,pFot,K) A1,V, , l 19s6
OWNER TELEPHONE NUMBER: (.21.5)- 734-4839
TAX MAP NO. : Section 1/7 Block 5- Lot 3?
CROSS STREET: 02.c4/4e-f) S?',eZe7-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing V
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: S•P yne3E2 3, 198E
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.)
Sig t e of Applicant
RECEIVED B Y: cgvY--E1-6-�. GPIs-G-
Town Clerk's Office
MOM
DATE:
NOV 14 in
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