HomeMy WebLinkAboutSkevofelix JUDITH T. TERRY Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK
REGISTRAR OF VITAL STATISTICS �` Southold, New York 11971
c� O �r Fax (516) 765-1823
MARRIAGE OFFICER =®��® �' � 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. 1970-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SKEVOFELIX, STEVEN
Mailing Address 1 P. 0. BOX 169
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2095 NEW SUFFOLK AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8190
Tax Map No. section 114.00 block 9 lot 13.000
Cross Street REEVE AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 9/21/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK •c�VFFOC,(��'`
Town of Southold �� CD '_ Application No. (�.
Judith T. Terry, Town Clerk k y
Town Hall, 53095 Main Road a �., 1 ,�: -'� $10.00 - Residential
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p. O. Box 1179 cn ;jx i z $25.00 - Non-Residential
Southold, New York 11971 �` �` ' ¢" ••`
Telephone _Q( -,1V--10 k '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. iel76
A tea.
Fee $/O ,, , XX
DATE WA' r7
OWNER NAME:
OWNER MAILING ADDRESS: P° ' /3 )\// / 6
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OWNER PROPERTY ADDRESS: p��n`, �� �9u--- ���s � I
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OWNER TELEPHONE NUMBER: „57-67
TAX MAP NO. : Section vs -:pock / Lot / 3
CROSS STREET: A- V
TYPE OF SYSTEM-: ��S'e tic Tank New Existing
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Cesspool New Existing
Residential, - ✓
Non-Residential
DATE
DATE OF PREVIOUS PUMP-OUT:
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 Applica
RECEIVED BY: , J ---- - -
-
Town Clerk's Office
DATE:
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