HomeMy WebLinkAboutVolinski (3) 4 :'
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Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
,�i! FAX(516)765-1823
JUDITH T.TERRY -� TELEPHONE(516)765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1322-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner VOLINSKI, JESSIE
Mailing Address 1 975 SHIPYARD LANE
Mailing Address 2 R.R. 1
City St Zip EAST MARION NY 11939-0000
Property Address 1 975 SHIPYARD LANE
Property Address 2 R.R. 1
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-1588
Tax Map No. section 38 block 1 lot 10
Cross Street MAIN ROAD
Date Of Last Pump Out 1/01/514
Issue Date: 11/29/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c���FD(,(��'- I
Town of Southold �� C�G• Application No. l13ac-
Judith T. Terry, Town Clerk 4a '
Town Hall, 53095 Main Road µ. ,� $10.00 - Residential
P. O. Box 1179 CS' ,,.A.
� 4_ s. � $25.00 - Non-Residential
Southold, New York 11971 O ® OBJ
Telephone ®j . •
�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION.
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1So?0?
Fee $ / d} OP
•
DATE / 1119, 51g7
•
OWNER NAME: TeS j C. VO B I nS k
ss f
OWNER MAILING ADDRESS: Uo i 976 cS1i 1 ( Y 4( �? e_
E451" 11 93 9
OWNER PROPERTY ADDRESS: Sq. yi'1. e, c[. 096
OWNER TELEPHONE NUMBER: 51(.0 L-/'7 1- l 5s1
TAX MAP NO. : Section \gtS? Block / Lot l O
CROSS STREET: '' . IA.i1 Al Ra A-4
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 0 93-
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 Applicant
At
RECEIVED BY: _��
lTrI> n CI:'k's 0 ice
DATE: • a
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