HomeMy WebLinkAboutSkirel JUDITH T. TERRY Zt• , � Town Hall, 53095 Main Road
F� P.O. Box 1179
TOWN CLERK
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER r ;1 '��� Fax (516) 765-1823
��"��� 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. 1691-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SKIREL, JESSIE
Mailing Address 1 OREGON ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 OREGON ROAD -
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6057
Tax Map No. section 84.00 block 1 lot 11 .000
Cross Street ROUTE 48
Date Of Last Pump Out 0/00/82
Issue Date: 5/22/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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IDFFICE OF THE TOWN CLERK �c.VFFO(,(���= `
Town of Southold �% CQG' , Application No. /2
Town Clerk is k_. y
Judith T. Terry, �►
Town Hall, 53095 Main Road z y ` -� $10.00 - Residential
p. 0. Box 1179Vg-,;;Vi .7 � ` $25.00 - Non-Residential
Southold, New York 11971 O ®. , &‘t".4•
411
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Telephone 41.' J l' : . -
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or-CESSPOOL - ,
Operation Permit No. l t, 9'`
Fee $ / 0
DATE
OWNER NAME: --!--,-*--- -e---- /1/-e.-- r--=2
OWNER MAILING ADDRESS: G9: e-.-,• 9--01
dC "fs.-e-i-e--,/. --kr, l
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 73 - 0_5-7
TAX MAP NO. : _ Section q. 7` Block / Lot I(
CROSS STREET: ' -R w ) "9-,,....„0:,,,----,4 Re)
,TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing — `'
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: / ? V
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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Signature of Applicant
RECEIVED BY: Air
- -
Town Clerk's Off'
DATE: 37/ 6797
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