HomeMy WebLinkAboutStepnoski (3) o��FFoi,��oG_,`
JUDITH T. TERRY F► Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
0.0 ,% Fax (516) 765-1823
MARRIAGE OFFICER .
�® 1® �� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3087-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner STEPNOSKI, FRANK T.
Mailing Address 1 1055 LITTLE NECK ROAD -
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1055 LITTLE NECK ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5372
Tax Map No. section 97.00 block 8 lot 2.000
Cross Street EUGENES ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 8/17/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
c
OFFICE OF THE TOWN CLERK Sc0FD(,-0„-
Town of Southold ca- Application No.S0V7
Judith T. Terry, Town Clerk ►'6\
Town Hall, 53095 Main Road ,jj - I $10.00 - Residential
• P. O. Box 1179 v' T7 $25.00 - Non-Residential
Southold, New York 11971 OO •= �0�,�`�
Telephone _ j
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ f G o5
-DATE . /. " '
OWNER NAME: y r 14 ) S 1
OWNER MAILING ADDRESS: /O 575-- L. 6 14 /Eck e
Oc is Ha7 --e,
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: rte ) )3 ��5 7e
TAX MAP NO. : Section '‘70 Block Lot
CROSS STREET: *‘`.(47 ,.G G7 ,C 5
TYPE OF SYSTEM: - Septic_Tank New Existing
Cesspool New Existing "
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
- 7 -of
Signatur' 'of Aplicant
RECEIVED BY: .
Town Clerk's Office
- DATE:
O ' os 4
,o&
a '
•
9
ate /
I �
fir
7)/
e