HomeMy WebLinkAboutPapish OFFICE OF THE TOWN CLERK
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Town of Southold ��R. ,CDG
Judith T. Terry, Town Clerk L`
Town Hall, 53095 Main Road -
P. O. Box 1179
Southold, New -York 11971 O .�
Telephone ,.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 67 Residential XX
Fee $ 10.00 Non-Residential
Septic Cesspool XX
NAME OF OWNER: Kenneth Papish
OWNER MAILING ADDRESS: Aux. 2, Box 64
Mattituck, ,New York 11952
--OWNER --PROPERTY ADDRESS: :Ol,e Jule-Lane
Mattituck,,1 New York
OWNER TELEPHONE NUMBER: 516-298-4572
TAX MAP NO. : Section 122 Block 5 Lot
2
CROSS STREET: New Suffolk Avenue
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TYPE OF SYSTEM: Septic Tank 'New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
•Orde‘lehe:,
Judith T. Terr
Southold Town Clerk
DATE: September 24, 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c�FFCU( '7Town of Southold ®�� - CQ�'_ Application No. (�
Judith T. Terry, Town Clerk
. 1., ts 'S Residential ‘/
Town Hall, 53095 Main Roadr q *;,
P. O. Box 1179 Non-Residential
Southold, New York 11971 5 ?e
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED APPLICATION
SEP 2 4 1986 for
Town Clerk Southold
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 6
Fee $ /0 °y
DATE -// 7'� 0
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OWNER NAME:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: ( 0 /
7:40/ on,/ zk? V /(
OWNER TELEPHONE NUMBER: --
TAX MAP NO. : Section 1/4"?6:77 Block Lot 0Z_,
CROSS STREET: fl ) ,d pa�� (20_6-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
Signature of A licant
RECEIVED BY: cce.cc_- 0. d_W9-6 t
Town/Clerk's Office
DATE: ),Lia_l_ezre-.-)
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