HomeMy WebLinkAboutPileski W 1 Town Hall, 53095 Main Road
�� P.O. Box 1179
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,y0 ® 'W 0. Southold, New York 11971
JUDITH T.TERRY ----....,,,,,,0740°.° 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. 694-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner PILESKI, FRANK
Mailing Address 1 BOX 944
Mailing Address 2 BARTLEY ROAD
City St Zip MATTITUCK NY 11952-0000
Property Address 1 BARTLEY ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4035
Tax Map No. section 144. 00 block 3 lot 25. 000
Cross Street BAY AVENUE
Date Of Last Pump Out 4/19/77
Issue Date: 5/11/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cvFFO(,r _ / G
Town of Southold �� 3 ,, ta- Application No4' j
Judith T. Terry, Town Clerk Residential
Town Hall, 53095 Main Road
P. O. Box 1179 u' fib 9W1474% ` Non-Residential
Southold, New York 11971 O�
Telephone ®.( �P ',
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ,D
DATES/ gg
OWNER NAME: Fie- A/A-1 s
OWNER MAILING ADDRESS:
;74/4--A/_, ivy
OWNER PROPERTY ADDRESS: at544- W/7,�/ `/ a7
OWNER TELEPHONE NUMBER: _ O 3 ;j
TAX MAP NO. : Section .����'3 -,25lock 3 Lot `f-- " O
CROSS STREET: l`/ 46/6-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: p,ii`L / 9 .7'3 / 9 l 7
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 Applicant
RECEIVED BY01 Geo, di 416,". ,�
RE ;:.:'Town ' lerk's I'ffice
DATE: MAY 111988
•
town Clerk Southold
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