HomeMy WebLinkAboutRakowicz OFFICE OF THE TOWN CLERK ' c,31FQ
Town of Southold Q4C°
Judith T. Terry, Town Clerk � + 7 x":
Town Hall, 53095 Main Road
P. O. Box 1179 c
Southold, New York 11971 ®� ° :ef0�- .�
Telephone •
(516) 765-1801 _ -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 182 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: STANLEY AND TERESE RAKOWICZ
OWNER MAILING ADDRESS: Box 447
Southold, New York 11971
OWNER PROPERTY ADDRESS: 455 Tuckers Lane
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-3104 (after 6:00 P.M. )
TAX MAP NO. : Section 59 Block 11 Lot 6
CROSS STREET: Route 25
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 9, 1986
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Judith T. Te y
Southold Town Clerk
DATE: December 18, 1986
(TOWN SEAL)
OFFICE OF THE TOWN OUr
Town of Southold ® MCQG',, Application No. f.°2--)
Judith T. Terry, Town Clerk .`, -
Town Hall, 53095 Main Road c Yy- &. Residential
Residential
cn r. .M
P. O. Box 1179 Non-Residential
Southold, New York 11971 O ® • r
Telephone 144 e ro,•_
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /IO2.}
Fee $ J U•°�
DATE /Wi1'�%
OWNER NAME: 5ffJ>'Y/ey /lyiow/r z
OWNER MAILING ADDRESS: /3 x cu/2
50v//#o/°.4 /, //77/
OWNER PROPERTY ADDRESS: ,� .5 j c' - G4-4/e
So v*//o/d� , //y, x/97/
OWNER TELEPHONE NUMBER: 76.c-- 5/0 ,5lFtey 6; f�/YJ
TAX MAP NO. : Section ,5'9 Block /7 Lot
CROSS STREET: JO-
TYPE
S'
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: a/9/-
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.)
Si a re ofPjOlicant
RECEIVED BY: ���C�. y -'
Town Clerk's Office
MEM
DATE:
yup 18 a
Town Clerk Southold
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