HomeMy WebLinkAboutSzala OFFICE OF THE TOWN CLERK cO't�(,l�
Town of Southold �Q ��' ;-
Judith T. Terry, Town Clerk �� 5 4,
Town Hall, 53095 Main Road te9M' 1
P. O. Box 1179 `i.
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Southold, New York 11971
Telephone "'e.( ki
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 591 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: John T. Szala
OWNER MAILING ADDRESS: 590 Budd's Pond Road
Southold, New York 11971
OWNER PROPERTY ADDRESS: 590 Budd's Pond Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-1827 -
TAX MAP NO. : Section 56 Block 5 Lot A-V7
CROSS STREET: Bay Home Road
TYPE OF SYSTEM: Septic Tank X New Existing x
Cesspool New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Te/'
Southold Town Clerk
DATE: January 29. 1988 ---- -
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(TQWN SEAL)
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OFFICE OF THE TOWN CLERK1fO - Q
Town of Southold ���, ,= ��QG Application Noss
Judith T. Terry, Town Clerk r . &'
Town Hall, 53095 Main Road "`-- -'� Residential
P. O. Box 1179 v' Non-Residential
Southold, New York 11971 O �*,_ �`
Telephone. �.(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - for -- - - _
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /O.
DATE Jan ad - / 911 -
OWNER NAME: je „,,f --
OWNER MAILING ADDRESS: a-5o £czrP •M s /,e
s", 0-r4-01 e_e/ ,u et /197f
OWNER PROPERTY ADDRESS: S.c, , r�
OWNER TELEPHONE NUMBER: '`? - ga 7
TAX MAP NO. : Section Block 3 Lot I
CROSS STREET: 6cer �fa%/yKe_.
TYPE OF SYSTEM: Septic Tank r/ New Existing co
Cesspool New Existing
Residential Non-Residential
- DATE OF PREVIOUS PUMP-OUT: la - 3 d f7
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.)
3a-Signature of A;plicant
RECEIVED BY: 40
� .
REankcyn Jerk's fice
DATE: JAN 2 9 EU
TOWS: Clerk Southold
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