HomeMy WebLinkAboutRakowicz (2) OFFICE OF THE TOWN CLERK S ic5�FFU(/'�+�
Town of Southold , 4.
Judith T. Terry, Town Clerk ti .
Town Hall, 53095 Main Road ,-- 'mac
?Y.
P. O. Box 1179
Southold, New York 11971 , •�
Telephone 7-0 *
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 616 Residential X
Non-Residential
Fee $ 10.00 Septic Cesspool X
NAME OF OWNER: Mitchell Rakowicz
OWNER MAILING ADDRESS: 2875 Hortons Lane
Southold, New York 11971
OWNER PROPERTY ADDRESS: 2875 Hortons Lane
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2190 - -
TAX MAP NO. : Section 59 Block 3 Lot 31
CROSS STREET: County Road 48
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT:
Judith,
Southold, Town Clerk
DATE: FEbruary 23. 1988
--(TOWN! SEAL)
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OFFICE -OF THE TOWN CLERK �COMA '��-
Town of Southold • CQ ' Application No.jp /
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road c4:4 t s� •r !h Residential
P. O. Box 1179 cn +- a .`' Non-Residential
Southold, New York 11971
Telephone
(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:
OWNER MAILING ADDRESS: �� -
,r //>7-
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 761” / ?d
__TAX MAP NO. : Section Block 3 Lot 3/
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
CesspoolL---- New Existing D
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: fId'�✓o (78"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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