HomeMy WebLinkAboutTyniec OFFICE OF THE TOWN CLERK ��fti[,t` "
Town of Southolddlj
Judith T. Terry, Town Clerk R '
Town Hall, 53095 Main Road ' _
P. 0. Box 1179 t.r2 '` g '
Southold, New York 11971
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Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation. Permit No. 536 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Doris Tyniec and Michael Capuano
OWNER MAILING ADDRESS: 1035 Alvahs Lane
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 1035 Alvahs Lane
Cutchogue, New York '
OWNER TELEPHONE NUMBER: 516-734-7401
TAX MAP NO. : Section 109 Block 1 Lot 25
CROSS STREET: Main Road I State Rt. 25)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown _
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Judith T. T' ry
Southold Town Clerk
DATE: December 14, 19R7
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c3vFFD(rC'Q'-
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Town of Southold OHO , ' � Application No. (53-6
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Judith T. Terry, Town Clerk � � � •,\ Residential
Town Hall, 53095 Main Road c a ? . -
P. 0. Box 1179 � � Non-Residential
Southold, New York 11971 O ® * r
Telephone ®i 0 '°
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(516) . 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
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OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
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DATE /
OWNER NAME: \b l'ii S ' 1, fir? ct. I ' C -',A Pi L C rAA
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OWNER MAILING ADDRESS: l 035 A)-vA h 5 LA lV'e--
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OWNER PROPERTY ADDRESS: j (� j5 Pt VA 1-., ✓� Ne.
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OWNER TELEPHONE NUMBER: 173 - Lf
TAX MAP NO. : Section 10 / Block / Lot 075—
CROSS
7S—CROSS STREET:
TYPE OF SYSTEM: GSeptic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
11,449.,ti
ign ure of Ap Ilcant
RECEIVED BY: • 1_ ..g.‘ , I, , �'-�_#,1
MEP *wn CI f k's Offi e
DATE:__DE_G444987 >
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