HomeMy WebLinkAboutSanok OFFICE OF THE TOWN CLERK • ' FO COIj - -
Town of Southold Q��F .
Judith T. Terry, Town Clerk - P1
Town Hall, 53095 Main Road 1�~
P. O. Box 1179 t n
Southold, New York 11971 Q ®_ �0�-
Telephone It/ '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
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Operation Permit No. 519 Residential X
- Non-Residential
- Fee $ 10.00
Septic Cesspool X_
- NAME OF OWNER: William J. Sanok
OWNER MAILING ADDRESS: Saltaire Way
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Saltaire Way
• Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-5078
TAX MAP NO. : Section 100 Block 1 Lot qq
CROSS STREET: Wave Crest
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: August 1986
. e
Judith T. T ry
Southold Town Clerk
DATE: December 4, 1987
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(TOWN SEAL)
OFFICE (31 THE TOWN CLERKcvFFULA' = '_
Town of Southold �� CQG'; Application No. L-5-7�
Judith T. Terry, Town Clerk
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{t �c
Town Hall, 53095 Main Road Residential
P. O. Box 1179 �' bre ' °� ' z Non-Residential
Southold, New York 11971 `1;;;",
*11.4-0-/
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Telephone .�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE J02Nd
OWNER NAME: VIL /Y /1/ s/51✓70,�
OWNER MAILING ADDRESS: 5-)W7 I H t h/ /�/%//
Mrs TT, 41 , 179s-2—
OWNER
2—
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: S-74 a 9 2 �o
00 I c3f;
TAX MAP NO. : Section -1/11—,— Block Lot
CROSS STREET: 1441/E C
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: �� / 47 cP
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.)
Signat e of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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/Acit 9‘ f,
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