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OFFICE OF THE TOWN CLERK F�
- Town of Southold Q ) COIj
Judith T. Terry, Town Clerk � �
Town Hall, . 53095 Main Road
P. O. Box 1179 n � .
Southold, New York 11971 p "®
Telephone vol j si
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 440 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Frank Sawicki -
OWNER MAILING ADDRESS: County Road 48
Southold, New York 11971
OWNER PROPERTY ADDRESS: County Road 48
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-3327
TAX MAP NO. : Section 51 Block 6 ' Lot 3.9
CROSS STREET: Clark Road - Richmond Road
TYPE OF SYSTEM: Septic Tank New • Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OFPREVIOUS PUMP-OUT: July 1987 -
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Judith T. erry •
Southold Town Clerk
DATE: September 28, 1987
(TOWN SEAL) •
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OFFICE OF THE TOWN CLERK c�VFFOL�4' `
Town of Southold % CQ Application No.��d
Judith T. Terry, Town Clerk % ��- { xs� - �'}
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Town Hall, 53095 Main Road �. -` ',rd =4 ! Residential
P. O. Box 1179 v' '' } ti. ; :L ,. Non-Residential
Southold, New York 11971 4 ; ; `-•�`
Telephone ®.�04 4 ��® ,�'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
fu r
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 5/170
Fee $ /0, 0----0
DATE 1` .2i / ba
OWNER NAME: r,0, I I a 5a.(,f,) i C i
OWNER MAILING ADDRESS: Cou.,n73/ Po:{{ La ((VOr7LA Pood-0
S 0 (kph o I Ji rNt y , 1/ 17/
OWNER PROPERTY ADDRESS: S Cl;-77 e,
OWNER TELEPHONE NUMBER: 7bp 33. 7
TAX MAP NO. : Section 51 ,r. Block 6 — Lot 3 ..
CROSS STREET: ez, e A92.,4,..,,,,„...,,, RI
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ' New Existing -
Residential Non-Residential
- DATE OF PREVIOUS PUMP-OUT: 9j. // 77LOCATION MAP: Must be attached hereto beforpermit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
__,/7,/,74/94. )4.140- ,'
Signature of Applicant
RECEIVED BY: dP 4. , I. r , ,i/:,, -
R""AVlown clerk's 'ffice
DATE: SEP 281981
Town Clark Southold
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