HomeMy WebLinkAboutSawicki (5) cAVU
•
c=a N Town Hall, 53095 Main Road
cr2P.O. Box 1179
`th Southold, New York 11971
, s,sem�,,
JUDITH T.TERRY = ®� hs' ���`,, TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN-OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 790-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner SAWICKI, WALTER
Mailing Address 1 OLD NORTH ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 OLD NORTH ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2250
Tax Map No. section 51.00 block 3 lot 6. 001
Cross Street COUNTY RT 48
Date Of Last Pump Out 0/00/00
Issue Date: 8/17/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
•
,
OEFICEOF THE TOWN CLERK ���FFO"�CQ•
FO
Town of Southold Application No. 7
Judith T. Terry, Town Clerk : '^ �
Town Hall, 53095 Main Road ~ � Y�x %.4, ")
Residential
p. O. Box 1179 tr3 �:a� : . �i Non-Residential
Southold, New York 11971 OO ��`
Telephone 0( ��
�'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER, DISPOSAL DISTRICT •
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $/0
DATE // 7/ff
OWNER NAME: I
OWNER MAILING ADDRESS: 1% DA0-7,,V1.- /2--e-44
44 '//ii . / 9 7
OWNER PROPERTY ADDRESS: S 1=1 M L
l
OWNER TELEPHONE NUMBER: / 76 - z S l7 +
TAX MAP NO. : Section / Block 2- % Lot -4- 6 , /
CROSS STREET:
•
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1/1 / 1d `6
J
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.)
f
•
Sign*(ure of Applicant
RECEIVED BY: c z
Ricavitywn C4erk's O ice
DATE: AUG Wen
town Cwt Southold
II
,1 .
. .
, .
,,../. . ..
. , .
,....
. . ,
. .
,
/ .
_ - 4, ... / -
. ,
• . ___
. .
, .
. _
. . ,
_ , •
. .
_ .
. ,
. . .
i
)--- -
,..,_ .
Cs S
N
,
Jib
, .
, -. 4 0
. ke‘Nr13\(- 't
. L7
.
. j, . . cr1
°11\'
- , 0.
.
, -
.. .
. .
•
. • ' '
, 0
, .
,. .
. . .
' .
, .
1 . .
1 .
1
. , .
. .
. .
, -
. . .
. . .
- .
_ - • . ,
_ . . .
. , .
. *
• ,
. .
. .
. .
. .
. .
. .. ,
. ,