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HomeMy WebLinkAboutSwotkewicz OFFICE OF THE TOWN CLERK 'cOf()Lire Town of Southold ®44`7 4,Z��tif0l/i� Judith T. Terry, Town Clerk Town Hall, 53095 Main Road _ r * ' P. O. Box' 1179 _° `r' ' s • Southold, New York 11971 Telephone 70/ lib (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION. PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 364 Residential X Non-Residential Fee $ 10.00 Septic Cesspool X NAME OF OWNER: Frank J. Swotkewicz OWNER MAILING ADDRESS: Box 607 Mattituck,-� New- York 11952 OWNER PROPERTY ADDRESS: Sebastian's Cove Road Mattituck, New York OWNER TELEPHONE NUMBER: 516-298-49174 " TAX MAP NO. : Section 107 Block 1 Lot 25 CROSS STREET: Mill Road TYPE OF SYSTEM: Septic Tank New Existing Cesspool X - New X Existing Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: N/A Judith T. Terry Southold Town Clerk DATE: July 29, 1987 (TOWN SEAL) e OFFICE OF THE TOWN CLERK c0FOC,rC Town of Southold �� • O;"G', Application No. A,' /�/ Judith T. Terry, Town Clerk �� �y� �� � -'• .G � Residential Town Hall, 53095 Main Road P. O. Box 1179 ' �:' Non-Residential Southold, New York 11971 O0 _ ��•'' Telephone : .( [ • -6 (516) 765-1801 TOWN OF SOUTHOLD • SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERAT ION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ gyp, Al DATE 7- oZ 3 OWNER NAME: A(/,NI -- OWNER MAILING ADDRESS: ja , 6o7 1.1/4-TT/7u G<, N.y //14-' OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: ,2yi 497y TAX MAP NO. : Section /p 7 Block / Lot, 059,5-' CROSS STREET: fr/ILL iJ TYPE OF SYSTEM: Septic Tank ✓ New '� Existing Cesspool ✓ New '� Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: neW 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.) Si.natur0 of Applicant RECEIVED BY: Town Clerk's Office DATE: _ r'r- �` . �X,•' •f;; l,- SUFFOLK CO. HEALTH DEPT. APROVAL C. / P r� `7t H. S. NO. G-56-:;:182s- ° - ("` G / fes, . - 4 ' U`/ ,, :. :-U i'�/I: .�Y , a. Fa S / • i C—..-- T I I:\ 1,- 1_,;,_. . . . , . , „ , , / A7 I `� 'hIC ? =b: f-, - . �, STATEMENT OF INTENT- , �. % f /t} �� a '. ' . /. --,2 r - - '`(VAC4tij'�-\ /- - - /t`,� ` t t \/ /1C THE WATER SUPPLY AND.SEWAGE DISPOSAL -�• k0 S` SYSTEMS FOR THIS RESIDENCE WILL �, .`ce. . r • ' CONFORM TO THE STANDARDS OF THE �,yes> / '' 9 / 1 ,IZ - SUFFOLK CO. DEPT. OF HEALTH- SERVICES. / ,. 6 i l . -� ---; !: r ,. _, i S► r l ! � . �-` — ✓--sa '; - - I' C ri t Yt�}t"- .J .� -N1it a� ; , a�, APPLICANT / / / - -�__�` SUFFOLK COUNTY DEPT. OF HEALTH � � 1 : SERVICES — FOR APPROVAL OF- �` _4��i CONSTRUCTION ONLY • jr, j✓'J ! _ . . \.. DATE: / Fav ,` v - �'ti H. S. REF. NO.. :15.5.7:.,50 ,:16 ._ ; / /7\ /` APPROVED: . . C3 r j L ' - l''' '-',:" ,' - i, ' . , . , • fi' ri J X . . \ SUFFOLK'CO: TAX' MAP'DESIGNATION: i _ . ,, ., -- -�'-- --- -- r = ilk - - - - , .� - - /,� ' ,gyp ' - -DIST SECT .BL'OCK -PCL” { _� ,, • , , .,/ c� �A?. '' !a��' �1�.,'' It - to ', 1077 - -- . • i .- ,: h �...'e> " , _ i,E L:'.1` y '` ! y<r I ' : ' • OWNERS ADDRESS: 'ate • 1 •' ' - =; .f..,� :, „fir` ;' `?` ,., •o�t =' �;` �'' �-� ;Mf`11 :i T.i. f.c.l4.i,is,:.`,y; 1 9X14l' • '� '`�3ta` . 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