HomeMy WebLinkAboutSledjeski 41'1' vuur
n ` ° Town Hall, 53095 Main Road
���" P.O. Box 1 179
_® - ��` Southold, New York 11971
JUDITH T.TERRY r� O
j,f TELEPHONE
TOWN CLERK (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. 935-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SLEDJESKI, BERTHA
Mailing Address 1 NEW SUFFOLK ROAD, #29 •
Mailing Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 NEW SUFFOLK ROAD
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-734-6785
Tax Map No. section 110.00 block 8 lot 26.000
Cross Street WICKS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 11/29/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �5�FF0(,r�'- ���-
Town of Southold �� CQ�';, Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road z." = -4 1 Residential
P. O. Box 1179 tri '`• 411,1 ' i ; Non-Residential
Southold, New York 11971 O`® e- ='A;,=\- °S
Telephone _ .( '.
(516) 765-1801
TOWN OF SOUTHOLD
RECEVED
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
k.s()V 1 (5198B
Tovn Cork Southold APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $/0, Oil `
DATE %/— /eel_ ak-
OWNER NAME: / jj7J:- SCI,X� , 4
OWNER MAILING ADDRESS: /
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OWNER PROPERTY ADDRESS: ,,Q�
OWNER TELEPHONE NUMBER: 7 ly _ G 7S-5
y TAX MAP NO. : Section j1!S Block cp Lot f-g-q-- . c Q 6
CROSS STREET: W f C /e S 'Po
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 1- New =--- Existing
Residential 1/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: M c.0_ , , y1/?8r
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 +f Applicant
RECEIVED BY: x & -
amiglT; n 4.'-k's Off ce
DATE: MOV g 9 SOB
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