HomeMy WebLinkAboutSieczka leaf Lt.
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JUDITH T. TERRY y Town Hall, 53095 Main Road
TOWN CLERK , p P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
Nl ��' Fax (516) 765-1823
MARRIAGE OFFICER ®/y � �' Telephone 516 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1976-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SIECZKA, JOSEPH B.
Mailing Address 1 6285 NEW SUFFOLK AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 6285 NEW SUFFOLK AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4423
Tax Map No. section 115.00 block 6 lot 30.000
Cross Street BLOSSOM BEND
Date Of Last Pump Out 0/00/00
Issue Date: 9/23/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OI FI E TOWN CLERK '��VFOUre'"
�' To of Southold � C•; Application No. `9719
Judith T. Terry, Town Clerk • 1) $10.00 - Residential
Town Hall, 53095°Main Road
P. O. Box 1179 74 4.rp" moi ;
$25.00 - Non-Residential
Southold, New York 11971 O •
Telephone Q( Y►�
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
a
Fee $ 10(j
DATE °i/ /99)2,-
,
OWNER NAME: h,S'eoAJ L SfecZ,i<.A-
OWNER MAILING ADDRESS: Akid .trP.OL1(— de, ,
,1-1--6 71rrf-) A/Ci /151
OWNER PROPERTY ADDRESS: jaw a r 41.-�
OWNER TELEPHONE NUMBER: A�6 Z3
TAX MAP _NO. : Section ,�11 Block P Lot .30
CROSS STREET: fat OSS'ttto & )
TYPE `OFSYSTEM: Septic Tank New Existing V
Cesspool New Existing V
. Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 4712494Z.
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.)
1 /r
/ / natureof Applicant/
RECEIVED BY: g :0_.....199:(9.
Town CI rk's Office
Imm
DATE:
EP 28 1992 •
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town Cly EON
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