HomeMy WebLinkAboutStepnoski (4) JUDITH T. TERRY
Town Hall, 53095 Main Road
TOWN CLERK3` 1 , P O. Box 1179
REGISTRAR OF VITAL STATISTICS _ j F_�,R! Southold, New York 11971
MARRIAGE OFFICER j4<_ >- , Fax (516) 765-1823
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. 1616-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HENRY STEPNOSKI
Mailing Address 1 RFD 3, NORTH ROAD
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 NORTH ROAD
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-765-2298
Tax Map No. section 74.00 block 1 lot 22.000
Cross Street HENRY'S LANE
Date Of Last Pump Out 0/00/00
-
Issue Date: 1/17/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
... •
OFFICE OF THE TOWN CLERK 'COFO(,-e'=
Town of Southold 4t® FRA-e,-
- Application No. ( ,1,
Judith T. Terry, Town Clerk % .a , /s . y
Town Hall, 53095 Main Road .4 -) $10.00 - Residential
P. O. Box 1179 cn • .f t. u+' ; $25.00 - Non-Residential
Southold, New York 11971 O ��
Telephone *.( y1��
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No._/ I
Fee $ 02 _o a
DATE ( � >i//y-d-
,_ , , ___
'OWNER NAME: `_••••e,,, ,_,44: , � fi _ ; __
OWNER MAILING ADDRE• ' : A _I z
ti _// ,.%;/,d y .1 r _ 'S 8
OWNER PROPERTY ADDRESS: /4!``, `
OWNER TELEPHONE NUMBER: f/J® 7 '5� -, 0
i?,e,,,g,,r77- ,
TAX MAP NO. : Section 7 Block / Lot
/ , CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing "-----------
Residential Non-Residential
IP‘aC4g/7/5d
DATE O,F�PRE/1 p JS PUMP-OUT: f+iJ -II �G���, ! ;,, AT/I ,, f ' ��
LOCATION MAP- Must be attached hereto before permit may be issued. /°Z�; -
4)
�� (Locate building and system; give north arrow and feet
��' `�
\i� I of distance, approximately to buildin• and closest road.)
) i�l'sIre j ' / 7 rot /� � �
mi
-IL NI ` ' //. //® rte�j /'/�:3 J
LJis'
'natur o Applicant
RECEIVED BY: W/341:., •' , % !
Town ery s Office r C
_ DATE: (.6c7 _...... 2.4-eioerz
/D° 00 �Jiiidl ter'
,` , .4‹, 1,j14077
jam'
.,I