HomeMy WebLinkAboutSkirel i1'1F® -fig. �®'
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4 MTown Hall, 53095 Main Road
��i P.O. Box 1179
=__ e -� ;•. Southold, New York 11971
JUDITH T.TERRY °��� FAX FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 972-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SKIREL, EDWARD
Mailing Address 1 WICKHAM AVENUE
Mailing Address 2 BOX 339
City St Zip MATTITUCK NY 11952-0000
Property Address 1 WICKHAM AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8887
Tax Map No. section 139.00 block 3 lot 33.001
Cross Street BAYER ROAD
Date Of Last Pump Out 11/30/85
Issue Date: 1/09/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
DI „.
OFFICE OF THE TOWN CLERK COMA' n
Town of Southold ��� n- �Q ' Application No.7 7
Judith T. Terry, Town Clerk `� �� A
Town Hall, 53095 Main Road µ� 7 Residential
P. O. Box 1179 f.ra _ 4i Non-Residential
Southold, New York 11971 4 ' ®r I%
esidentiaix. 1 •
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE la-
OWNER
a-OWNER NAME: k/2, PvC�. J �
OWNER MAILING ADDRESS: g°&AID Al 13® 33 7
m Ora-
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 9-78- °'",: t ' ' -
TAX MAP NO. : Section /3 9 Block 3 Lot 8B
CROSS STREET: � � �„ _ � � P �ee
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /if-3 0-
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 Applicant
RECEIVEDI1L: � � ' •
wn lerk s Of ice
DATE: DEC 27 1988
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