HomeMy WebLinkAboutOvisinak v Jy, ; �. Town Hall, 53095 Main Road
�� P.O. Box 1179
•
® ��., ���� '' Southold, New York 11971
NDITH T.TERRY FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1158-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner OVISINAK, BARNEY
Mailing Address 1 ALVAHS LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 ALVAHS LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6937
Tax Map No. section 101 .00 block 2 lot 17.000
Cross Street ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 6/16/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• 'S.
OFFICE OF THE TOWN CLERK c.31FO(�'�
Town of Southold �� -,.. "4' ..--: Application No.fiX
Judith T. Terry, Town Clerk i '.4.7.:3 4 r�` .
"" •,;-4-� 4 7 $10.00 - Residential
Town Hall, 53095 Main Road � s�,� �,�'
p. O. Box 1179 to 4 ,Wi ; $25.00 - Non-Residential
Southold, New York 11971 O - �1
Telephone *0.4.--`j►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
i
Fee $
DATE 3 ` 13 --
OWNER NAME: - e /'ice / D //dj 4/. ,--
OWNER MAILING ADDRESS: A.f43J' / /7.2
/0 7.-i. /Zb �./G 7/ U l' -5-------
OWNER PROPERTY PROPERTY ADDRESS: ,9Z 1/,9,4'-/Y r%/32l/`~-
C /-�?//c K /6 fi// "Li-d----
OWNER TELEPHONE NUMBER: 73 /- f&7. h
1
TAX MAP NO. : Section /0,1 Block a Lot / 7 E'
CROSS STREET: ,a (/7-6.-. '-
i
TYPE OF SYSTEM: Septic Tank New Existing L'•
Cesspool V • New Existing !
Residential Non-Residential 1!
r. 3
DATE OF PREVIOUS PUMP-OUT: /I,
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.)
i
r
9g).4•41.--(q (9t6-444'1-('` , i _
Siture of Applicant
RECEIVED BY:
v i n Clerk's Office
DATE: JUN 1 ', 19b1
1
-\, \ V'
--7- ,..177-----
Q
i ____-,
d_ V Cp
v�
\�
J
c.--)
t