HomeMy WebLinkAboutSlawski JUDITH T. TERRY ' Town Hall, 53095 Main Road
TOWN CLERK ` t P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .�` Southold, New York 11971
MARRIAGE OFFICER Q o ��,' Fax (516) 765-1823
401„ ��®.�! 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. 3048-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SLAWSKI, ANNA M.
Mailing Address 1 P. O. BOX 32
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 OYSTERPOND LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2450
Tax Map No. section 24.00 block 1 lot 3.000
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/00
Issue Date: 6/28/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �®
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Town of Southold CQ Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road " $10.00 - Residential
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P. O. Box 1179 u' }. 3' 'h�i ; $25.00 - Non-Residential
Southold, New York 11971 O
Telephone O! * N�0,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 1 7
OWNER NAME: .� ,;,�, ,=� �:,�,� 1741�--� � ;U S r uL)
OWNER MAILING ADDRESS:
(-) r N }/ I / 9 7
OWNER PROPERTY Y ADDRESS: S L
d'‘ 1 \ 9 57
OWNER TELEPHONE NUMBER: 5-7 C — �. .. ~®
TAX MAP NO. : Section Block Lot
CROSS STREET: -"F (Ad A
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing .
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: n/' C I ¶ 3
. . 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.) 2c-"
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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