HomeMy WebLinkAboutStepnoski OFFICE OF THE TOWN CLERK .c0F[1(I10+"
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Towof Southold oQ "Gy
Judith T. Terry, Town Clerk 1%
Town Hall,' 53095 Main Road i
P. O. Box 1179 �`µ "
Southold, New York 1197. 1 •
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Telephone VO/ ��.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
OPERATION PERMIT
SEPTIC TANK or CESSPOOL .
Operation Permit No. 402 Residential X
- Non-Residential
- Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Frank Stepnoski Jr.:and Catherine
OWNER MAILING ADDRESS: RR2, 400 Marlene Lane
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 400 Marlene Lane
• Matttituck, New York
OWNER TELEPHONE NUMBER: 516-298-5478
TAX MAP NO. : Section 143 Block 2 Lot 24
CROSS STREET: Route 25 and Peconic Bay Blvd.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X'Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: February 1986
I .r1!th T- Terry
Southold Town Clerk
DATE: August 14, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ��F F cur
Town of Southold �� CQ�' , Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ko :4,I Residential
P. O. Box 1179 rte .; � Non-Residential
Southold, New York 11971 T.. ��,�`
Telephone ®1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
} Fee $ /6
DATE al 1ld 7
OWNER NAME: an , } pncr-40 q{. I (mfI nt
OWNER MAILING ADDRESS: /40 incsflenc Lane 02Q*2)
OWNER PROPERTY ADDRESS : 5 t"
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 114 3 Block Lot a4
CROSS STREET: ( 5 ` 'pn1Ca) e a..
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing
Residential Non-Residential
- -- DATE OF PREVIOUS PUMP-OUT: 1(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.)
694-PAI4L-%
(9dk
Signature of Applic nt
RECEIVEIXEFAVEDc —L-c
Town Cl k's Off ce
DATE: AUG 171997
Tom ,Clerk Southold
ith
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