HomeMy WebLinkAboutVolinski (2) OFFICE OF THE TOWN CLERK --A s `'OFeU(i;
Town of Southold �� ;- � ��
Judith T. Terry, Town Clerk D t= • ` e
Town Hall, 53095 Main Road c it.
P. O. Box 1179 ; �;,.•.:_ ••
Southold, New York 11971 O } 'M s �- •�
Telephone =AA~rt
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 291 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Benjamin Volinski
OWNER MAILING ADDRESS: P.O. Box 761
Southold. New YOrk 11971
OWNER PROPERTY ADDRESS: Clearview Avenue . . .-
Southold.
Southold. New York
OWNER TELEPHONE NUMBER: 516-765-3223
TAX MAP NO. : Section 70 Block g Lot 54
CROSS STREET: Mailer Court
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
r,„ ;to:
Judith T. Terry
Southold Town Clerk
DATE: April 30, 1987
(TOWN SEAL)
II Ili
OFFICE OF THE TOWN CLERK ��FF��,�'-
Town of Southold �� s lD Application No. a (
Judith T. Terry, Town Clerk . '` ►
Town Hall, 53095 Main Roadr Residential
P. O. Box 1179 - i' Non-Residential
Southold, New York 11971 0fit
Telephone 1%44-0e°
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. c /
Fee $ /•b
DATE '
OWNER NAME: EJV (rYt1 Ili Vo /_ 1419kB°
OWNER MAILING ADDRESS: 1 b . 6(5y. 7/ f
Sova l�oLD �/'
OWNER PROPERTY ADDRESS: C Jflh/ (,iJ
v�
•
.v,/, 1/97/
OWNER TELEPHONE NUMBER: �5 /b -, 7
a TAX MAP NO. : Section v Block 9 Lo6-9
CROSS STREET: Tr)a.<1
TYPE OF SYSTEM: Septic 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.)
/
.fir ef, m'
RECEIVED BY: Gds
Town C rk's O ice
DATE: