HomeMy WebLinkAboutOrlowski OFFICE OF THE TOWN CLERK k.414 Town of Southold •
Judith T. Terry, Town Clerk � � _
Town Hall, 53095 Main Road
P. 0. Box 1179 cfl
Southold, New York 11971stt•
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 238 Residential X
Non-Residential
Fee $ 10.00 Septic Cesspool X
' NAME OF OWNER: Bennett Orlowski
OWNER MAILING ADDRESS: P.O. Box 266
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: New Suffolk Road
Cutchogue, New YOrk
OWNER TELEPHONE NUMBER: 516-734-6040
TAX MAP NO. : Section 110 Block 8 Lot 13
CROSS STREET: Oak Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
• DATE OF PREVIOUS PUMP-OUT: 3/20/87
90-
Judith T. Terry
Southold Town Clerk
DATE: March 20, 1987
(TOWN SEAL)
�_ /AL,
OFFICE OF THE TOWN CLERK affair
Town of Southold Application No. v�
Judith T. Terry, Town Clerk ;
Town Hall, 53095 Main Road o�� ,"
t Residential
P. O. Box 1179 cn fir; r r .`' Non-Residential
Southold, New York 11971 O }r ��`
Telephone 4e t s��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. c,23/
Fee $
DATE 7120.1) , ! 9 n
OWNER NAME: . ( nhQ7`f Or c,t)s
' Y E �\
OWNER MAILING ADDRESS: _ m
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: '- - a L
TAX MAP NO. : Section f j 0 Block ( Lot
CROSS STREET: e_A - 0 >4 f
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool � New , Existing !/
Residential J Non-Residential
DATE OF PREVIOUS PUMP-OUT: 3 J2 �,'tc
rr
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.)
1114'1.,--17t24/At-A-
Signaturb of Applicant
RECEIVED BY:(, ���
Town CI k's 0 f ce
DATE: V'A? A`7
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