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OFFICE OF THE TOWN CLERKFQ
Town of Southold ��F ����
Judith T. Terry, Town Clerk , :—
Tow
Town Hall, 53095 Main Road
P. 0, Box 1179 v' ux
Southold, New York 11971
Telephone A'L F'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 89 Residential xx
Non-Residential
Fee $ 10.00
Septic Cesspool xx
•
NAME OF OWNER: Charles Miska
OWNER MAILING ADDRESS: P.O. Box 111, New Suffolk Avenue
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 4475 New Suffolk Avenue
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-4312
TAX MAP NO. : Section 115 Block 4 . Lot 33:4 '
CROSS STREET: Marratooka Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool xx New Existing xx
Residential xx Non-Residential
DATE OF PREVIOUS PUMP-OUT: August 26, '1986
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Judith T. Terre
Southold Town Clerk
DATE: October 15, 1986 '
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(TOWN SEAL) • _,
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OFFICE OF THE TOWN CLERK ��FO
Town of Southold �o CQ Application
Judith T. Terry, Town Clerk �►
� " ���,�., .G 7 Residential
Town Hall, 53095 Main Road c Y pi/A -
P. O. Box 1179 ur3 , �:` Non-Residential
Southold New York 11971 O ® riice- �'
Telephone _ 1 —‘0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED APPLICATION
OCT 15 ig8for
town Clerk Southold OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. C1 -
Fee
$ /-U
DATE C 1 sem, Q (®
OWNER NAME: C. tAAAL � ES
OWNER MAILING ADDRESS: 0 �� l ( Yr.) a I Vi El:- 41471 d1
(��o,9. t\i ;, I 1 Ut c
OWNER PROPERTY ADDRESS: C�.C\' h� \ a� �� 1= P 44-47
OWNER TELEPHONE NUMBER: -f
TAX MAP NO. : Section //5" Block `7 Lot g.3„ 4/
CROSS STREET: `77-)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing a/
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: ' l (tv ,V*
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.)
Signature of Applicant
RECEIVED BY: (4--6-1(_0(64 -
Town k's Off' e
DATE: j-M.. d.5`, /yOPC-
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