HomeMy WebLinkAboutVaitis recif
i!`et° Town Hall, 53095 Main Road
JUDITH T. TERRY
'`4 'az t P.O. Box 1179
TOWN CLERK ® u--ri t+
REGISTRAR OF VITAL STATISTICS o .�` Southold, New York 11971
MARRIAGE OFFICER �� Fax (516) 765-1823
�� �. Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1933-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner VAITIS, TERESA
Mailing Address 1 BOX 783
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 3595 NEW SUFFOLK AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4745
Tax Map No. section 115.00 block 3 lot 26.000
Cross Street AIRPORT DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 6/24/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
O FkL' OF THE TOWN CLERK c31FDUI?, : 2�
Town of Southold � {:,• CQ Application No. � ( J
Judith T. Terry, Town Clerk 4`') $10.00 - Residential
Town Hall, 53095 Main Road
P. O. Box 1179
$25.00 - Non-Residential
Southold, New York 11971 O '®iryr "'
Telephone
(516) 765-1801
TOWN OF SOUTHOLD ,
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No.
Fee $
DATE /iP/?
OWNER NAME:
OWNER MAILING ADDRESS: BOY 7f j
ihvc1< iy,V figs a,
OWNER -PROPERTY ADDRESS: q� J\I I✓tL Su f f Lit ' V -1
OWNER TELEPHONE NUMBER: a 1- 4'746 •
TAX MAP NO. : Section /15 Block 3 Lot 6,
CROSS STREET: A a, , Alt! , , •
TYPE 'OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: r51-i
LOCATION MAP: Must be attached hereto be ore permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
V,��4lll i�7i !/ /L�
Signature of Applicant
RECEIVED BY: =
Town Clerk's Office
•
DATE:
RECEIVED
JUN 19 1982
5oullolcl Town Clerk
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