HomeMy WebLinkAboutSepko JUDITH T. TERRY Town Hall, 53095 Main Road
• TOWN CLERK O T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER g® � � Fax (516) 765-1823
--Ago �bO Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3072-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SEPKO, ROSE
Mailing Address 1 9080 SOUND AVENUE .
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 9080 SOUND AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8440
Tax Map No. section 122.00 block 2 lot 1 .001
Cross Street FACTORY AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 7/27/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �F �FO a
Town of Southold ��_,.- C . Application No. JO 7'71'�� O�
Judith T. Terry, Town Clerk \ y '`
Town Hall, 53095 Main Road = �, $10.00 - Residential
P. O. Box 1179 53111%. ` : $25.00 - Non-Residential
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Southold, New York 11971 VO :® 1 st;
Telephone 4,01-41-
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT '
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE/ 7-- 26 - 93
OWNER NAME: /F®� e Sapio
OWNER MAILING ADDRESS: gag® Som-nd %ve.
4( a "rn 1 L /` lv Y 1)(52-
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)(52.-- OWNER PROPERTY ADDRESS:-- - �.q v►.
OWNER TELEPHONE NUMBER: ?,(111-(P
TAX MAP NO. : Section Block Lot ! I
CROSS STREET:
c 7 3 /9 J2.-2 4Ct ab t-c_
TYPE OF SYSTEM: -Septic Tank New Existing
Cesspool New Existing El t 'ea-
Residential A' Non-Residential
DATE OF PREVIOUS PUMP-OUT: — Z q — !Q 3 C35 a !AL)
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.)
Sign ure Applicant
•
RECEIVED BY:
Town Clerk's Office
DATE:
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