Loading...
HomeMy WebLinkAboutPrilucik I ? FO( 6 s COG' JUDITH T.TERRY �� � �� Town Hall, 53095 Main Road TOWN CLERK693 P.O. Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS VG). ® MARRIAGE OFFICER N °� Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER - '1 `�eaA,I Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER � OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3443-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner PRILUCIK, JOSEPH Mailing Address 1 718 CLARENCE AVENUE Mailing Address 2 City St Zip BRONX NY 10465-0000 Property Address 1 320 EUGENE'S ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 718-792-4808 Tax Map No. section 97.00 block 6 lot 3.000 Cross Street ROUTE 25 Issue Date: 3/01/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) - - - • „,, OI1FICE OF THE TOWN CLERK '��FFO Town of Southold , &_�� COG Application No. 3 � / Judith T. Terry, Town Clerk i. Town Hall, 53095 Main Road a < $10.00 - Residential P. O. Box 1179 u' art �' $25.00 - Non-Residential Southold, New York 11971 O ��'`, � Telephone :V.( Y% (516) 765-1801 r TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE 2 f:/ � OWNER NAME: 1 • 1 R-) LliCI << OWNER MAILING ADDRESS: 7l g 4 ' .E Svc I?fti7 Ai-7 tb 4 gd'' OWNER PROPERTY ADDRESS: .520 �"�-&-.-"&3 'A,-b OWNER TELEPHONE NUMBER: 7, 1 - 7 7 - egO B TAX MAP NO. : Section 9 7 Block 6 Lot -CROSS STREET:' . 2 rr TYPE OF SYSTEM: -`•Septic"-Tank-`-3_=`= - --- New Existing Cesspool New Existing Residential Non-Residential 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 RECEIVEDL ' BY. /411 '..'"': - -- - __•._ --- -- - ---- ' `' Town'•Clerk's Office ` • �'•• ' DATE':, 4 -' c o _ // - f �y! 0 / o eY / , • AD U C-t t`�: , :Q S.Fo8•42'4o" E. — :37t_86 6.'74`OS.40- . 274 B to 43 2 \*......."\ , sl• ©a M N to ' \ 'j. •`ate f'' `>t"�`! p o iv PCs i IV Cli \��T .z \` mfr f l • / \ t•, ERATION nOR O r`� S. TO THISORIZED SURVEY ISTA VIOLATION OF ADDITION SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. P ; OVEY MEG 1i r-y a`� THECOPIES LAND F SUTHISRVEYORSURS INKEDAP SEALNOT ORBEARING 1 EMBOSSED SEAL SHALL NOT BE CONSIDERED 5�..J2v \lCID r--0 TO BE A VALID TRUE COPY. �,,..,,y !, kr GUARANTEES INDICATED HEREON SHALL RUN '�-„ir i 1 t �`, t r'- ONLY TO THE PERSON FOR WHOM THE SURVEY i- U L , �` . t- r.,.-_1'L. .. -,,,i.i' IS PREPARED, AND ON HIS BEHALF TO THE AT TITLE COMPANY, GOVERNMENTAL AGENCY AND C 'L,TJ'! p_'" '. (`^-•0 LENDING INSTITUTION LISTED HEREON, AND -- 7 C (.7-, ' E. TO THE ASSIGNEES OF THE LENDING INSTI- 7 O\Vt..:f• OF SQ(} 4 I b aI 1,,/.Y. TUTiON. GUARANTEES ARE NOT TRANSFERABLE _ TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS , GUA2Ai ITC;EJ TD Ti-IE SECUtZt-t"y TITLE AND t-UAUANTY' CONAPA NY AND `1"I---1E SOUTHGLG E.:-. S A V I:tel G 5!�N t) It20N Pi PE 3U2Ve\,/6 �,;JGj"`��.:.r.;�' ta;l t°!. _ t�sor•ruI�lEri-; VAN TUY'L_ & SON r,',,.° i'7' %a-7 Li':� s��'`._. LICENSED L AND S)14, ...-\-1,EYO(?5 A2.E=A -- �. OZ G �'4,t...2I-- CA2.PE:.IP02_-r, NE:W°Yo[?IL