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HomeMy WebLinkAboutSosnowski • a � s ,) C3 y�r?.0 h `;� E;tYp Town Hall, 53095 Main Road e� a �; P.O. Box 1179 G1�Y Southold, New York 11971 JUDITH T.TERRY FAX(516)765-1823 TOWN CLERK TELEPHONE(516)7654801 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. 1025-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner SOSNOWSKI, WALTER Mailing Address 1 1165 SHIPYARD LANE Mailing Address 2 City St Zip EAST MARION NY 11939-0000 Property Address 1 1165 SHIPYARD LANE Property Address 2 City St Zip EAST MARION NY 11939-0000 Owner Telephone No. 516-477-1890 Tax Map No. section 38.00 block 1 lot 13.000 Cross Street MAIN ROAD Date Of Last Pump Out 0/00/00 -- § ,+'� ---- Issue Date: 2/15/89 Judith T. Ter Southold Town, Clerk (TOWN SEAL) • / V. ' OFFICE OF THE TOWN CLERK -t3\\ FDC,f • � Town of Southold C'OG, Application No/.0 ,-L-- Judith o/. , rJudith T. Terry, Town Clerk „v-.47',.4 y Town Hall, 53095 Main Road o 'e 1 Residential P. O. Box 1179 "i • � .,� �1,•• Non-Residential Southold, New York 11971 4 Telephone 10 • (516) 765-1801-- _ TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT - APPLICATION - for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. /e Fee $ Jls'�:U a - - - DATE Fel , — Her OWNER NAME: ( LT hb 3 1r OWNER MAILING ADDRESS: f l s- S d -4 OWNER PROPERTY ADDRESS: g yr) e OWNER TELEPHONE NUMBER: L{ 77-1 9 Re TAX MAP NO. : Section 3 Block / Lot I CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool NA\ New Existing )( Cn) Residential Nk, Non-Residential DATE OF PREVIOUS PUMP-OUT: dtL LOCATION MAP: Must be attached hereto before permit may be issued. 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