HomeMy WebLinkAboutPawlik (2) 0 N3
JUDITH T. TERRY % �� Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK
REGISTRAR OF VITAL STATISTICS C rrt + Southold, New York 11971
MARRIAGE OFFICER � Fax (516) 765-1823
� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1733-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PAWLIK, STEPHEN
Mailing Address 1 P. O. BOX 1611
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 550 SOUTH DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5412
Tax Map No. section 106.00 block 11 lot 11 .000
Cross Street BAYVIEW AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 8/08/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
5
ih
Au •
} I
OFFICE OF THE TOWN CLERK 'S\\FFOur
town of Southold ,&% �CQ`* .4‘
'� Application No. I Z �3
Judith T. Terry, Town Clerk • k y
Town Hall, 53095 Main Road
$10.00 - Residential
p. O. Box 1179u' $25.00 - Non-Residential
Southold, New York 11971 O .® '
Telephone SO- y►� .'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: i.' '_
OWNER MAILING ADDRESS: 77A / //�
h` NY- 1L Z
-OWNER PROPERTY ADDRESS:
f cI$J
OWNER TELEPHONE NUMBER: `'l�V/2
TAX MAP NO. : Section /0e, Block_M6 Lot //—1
CROSS STREET: Igsa ti4, J4ire
TYPE OF SYSTEM: Septic Tank New Existing v"
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.)
y.ree
Signature of Applicant
RECEIVED BY: /1-/
Town Clerk's Office •
DATE:
STEPHEN M. PAWLIK
P.O. Box 1611
Mattituck, NY 11952
516-298-5412
Retaining Walls Brick Walkways
Decks s Beach Stairs
Bulkheads Docks
tO,"/ 4J7I
c-o l"\Of(jit-
Cesspcol