HomeMy WebLinkAboutPylko JUDITH T. TERRY ; ` Town Hall, 53095 Main Road
TOWN CLERK O T P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS as Southold, New York 11971
MARRIAGE OFFICER _ yQ / 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. 2067-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PYLKO, ZIGMOND AND WIFE
Mailing Address 1 P. O. BOX 53 -
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 3805 OLE JULE LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4913
Tax Map No. section 122.00 block 5 lot 26.000
Cross Street KRAUS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 3/05/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c3�FFO(,r 9yi
Town of Southold � CQG' Application No. ao6
Judith T. Terry, Town Clerk
LL
Town Hall, 53095 Main Road -. _; s, $10.00 - Residential
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P. 0. Box 1179 � -r. -Y ' � $25.00 - Non-Residential
Southold, New York 11971 O - • $
Telephone
Telephone :.( 44
0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 5 - 3
OWNER NAME: Z /G740 /VD Z fe0
OWNER MAILING ADDRESS: ®LC \Jude- L „/b -Po Ao$
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OWNER PROPERTY-ADDRESS: 3 o JC"L LR.v -
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OWNER TELEPHONE NUMBER: 07 7,8
TAX MAP NO. : Section /Z,2 Block 3 Lot
=CROSS STREET: )
TYPE, OF ,SYSTEM-: Septic-Tank ;---------- New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7 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.)
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Signatu e of Ap„Iicant
RECEIVED. BY: •
Town Cl-rk's Office
DATE:
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