HomeMy WebLinkAboutTomaszewski J.
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JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK ` P.O. Box 1179
Cia
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 1 ® ►► Fax(516) 765-1823
MARRIAGE OFFICER �y � Ii�► Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER ‘79./ jig as0
FREEDOM OF INFORMATION OFFICER ,,its
OFFICE OF THE TOWN CLERK •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3658-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner TOMASZEWSKI, THOMAS/MARY ELLEN
Mailing Address 1 3275 ALDRICH LANE
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 3275 ALDRICH LANE
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-4647
Tax Map No. section 124.00 block 1 lot 5.000
Cross Street RT. 25 AND SOUND AVENUE
Issue Date: 7/23/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cvVF°Or��G 36 L O
Town of Southold �� = Application No.
Judith T. Terry, Town Clerk �� '' `: r �1
Town Hall, 53095 Main Road , ,; -'4 I $10.00 - Residential
P. O. Box 1179 tr3 $25.00 - Non-Residential
Southold, New York 11971 O 0 ••••;::•:`c.
Telephone ( •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE' 6/7/3C/F7
OWNER NAME: /A/o/14,4-5 - A4--fe/ F//e•Adi ./® 44/9•' 5
OWNER MAILING ADDRESS: Y2. 7S- ,4/ r l-4 #241,-)�
_OWNER PROPERTY ADDRESS: St/44U:
OWNER TELEPHONE NUMBER: C1 - - V' r
TAX MAP NO. : Section /2-/'
Block 0 / Lot
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CROSS STREET: - id -�
TYPE OF SYSTEM: Septic Tank New Existing
p.
Cesspool New Existing
Residential Non-Residential
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 Appl'c nt
RECEIVED BY:
Town Clerk's Office
DATE:
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P\ REVISIONS YOUNG & YOUNG
FE6,?B,/973
400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
414 Y /G, /77 3
AUG 8, 1973 ALDEN W. YOUNG HOWARD W. YOUNG
rC PROFESSIONAL ENGINEER AND LAND SURVEYOR
- -- - _ ,^,tt,n•r FT.�•cLTil �isFtLRT1 �Pj2' LAND SURVEYOR. N V.S LIC NO 12845 N.Y S. LIC. NO. 45893
. L, 2.o� _ SURVEY FOR: �e OF vfy
��,�,�AUG-`�r� 1�1� Fi. '�i• r S= H. WILLIAM SCHUTTE B GERALDIN• - •� v�
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t= MONUMENT '-''" ' ' • - LAUREL HO'rict lTL"DIVISG CHIC-GO
• +o bo.7.,: vLali_:(.C,(.Ttj'u TITLE 11S �A�'_LECO.
:Sb'y=lot TOWN OF SOUTHOLD SOUTH�LQ•�;QIN itf,
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SUFFOLK CO., N. Y. /c-a2<.�-✓1Gt //-.