HomeMy WebLinkAboutSolecki .07
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Town Hall, 53095 Main Road
��`� P.O. Box 1179
=_` Southold, New York 11971
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JUDITH T.TERRY ®� �1i�4 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. 1436-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SOLECKI, JULIAN
Mailing Address 1 MAIN ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-298-8836
Tax Map No. section 109.00 block 1 lot 2.000
Cross Street LOCUST AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 4/04/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'SFOUre
Town of Southold �sz ,Q _ n �G- Application No. /1134
Judith T. Terry, Town Clerk �y" ° y
Town Hall, 53095 Main Road -1:"%;? $10.00 - Residential
P. O. Box 1179 cr3 fi sir
t $25.00 - Non-Residential
Southold, New York 11971 O ® ; yam
Telephone '01 %' )
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
•
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATERT21 )h /190
OWNER NAME: J �J 1, 1 p Ar Sa g-ce(�
OWNER MAILING ADDRESS: ,2 9- i/i g ow_
0 17113
OWNER PROPERTY ADDRESS:
• OWNER TELEPHONE NUMBER: 51C d 9 9,3 aga6
TAX MAP NO. : Section /0 9' Block / Lot
CROSS STREET: A,o ( r r,
TYPE OF SYSTEM: Septic Tank Al New Existing !'
Cesspool } New Existing fi
Residential ( Non-Residential
DATE OF PREVIOUS PUMP-OUT: U i( )/ 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
RECEIVED
own Clerk's Office
DATE: APR 041990
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