HomeMy WebLinkAboutVolinski JUDITH T. TERRY ; 6°‘ Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �IT" .�. $
Southold, New York 11971
MARRIAGE OFFICER V®® , ,% Fax (516) 765-1823
��® ��' Telephone (516) 765-1801
41 s.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1655-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner VOLINSKI, CONRAD AND MARJORIE
Mailing Address 1 1625 SHIPYARD LANE
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 1625 SHIPYARD LANE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-1634
Tax Map No. section 38.00 block 1 lot 17.000
Cross Street ROUTE 48
Date Of Last Pump Out 0/00/83
Issue Date: 4/08/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
^1,4 /I-
OFFICE-TF THE TOWN CLERK •��FFDu. /‘(....675---_
Town of Southold C • Application No. / 3
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
6.•� #•-"ter
P. O. Box 1179 u7 t:'" � $25.00 - Non-Residential
Southold, New York 11971 O ®_ O� ���
Telephone � '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /
DATE /M,Cti 1 /F5/
OWNER NAME: VOL(CO/vA`a-D//VI ,e-`502(6- A) c (C I •
OWNER MAILING ADDRESS: RU ' /�O S �' P ',,12 .r7 44/1/
/1714 /0 et), N - V- 1 ( 5� j
OWNER PROPERTY ADDRESS : S cM 6
OWNER TELEPHONE NUMBER: Jul 7 7 ? tt3 Se
TAX MAP NO. : Section Block I Lot l7
CROSS STREET: 160 ( 6 Lig
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 1.7 New Existing '---7
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 19 3
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.)
n
Cr—' SSiiggnature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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