HomeMy WebLinkAboutVolinski (4) - OFFICE OF THE TOWN CLERK $ FO
Town of Southold
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Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road4
P. 0. Box 1179 cin . �; , z,
Southold, New York 11971 p , .V ; r �- •�
Telephone j i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No. 389 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Jessie Volinski
OWNER MAILING ADDRESS: 975 Shipyard Lane
East Marion, New York 11939
OWNER PROPERTY ADDRESS: 975 Shipyard Lane
East Marion, New York
OWNER TELEPHONE NUMBER: 516-477-1588
TAX MAP NO. : Section 38 Block 1 Lot 11
CROSS STREET: Main Road (Route 25)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 13, 1980
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Judith T. Ter
Southold Town Clerk
DATE: August 7, 1987
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; (TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'SOFULk-
Town of Southold Application No. ,3t9
Judith T. Terry, Town Clerk y 4„, •: l Residential
Town Hall, 53095 Main Road
P. O. Box 1179 `' � r •`' Non-Residential
Southold, New York 11971 O ",,"�
Telephone "fo400
0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3 d,
Fee $ /d
DATE 51 183
OWNER NAME:__
OWNER MAILING ADDRESS: q9.5 Sh ?yard /..Qh e
E QS m ca r1 N-y 11939
OWNER PROPERTY ADDRESS: Sh l
q Aa r a e n -\f tic 35
OWNER TELEPHONE NUMBER: L°1 7`?' , J R2
TAX MAP NO. : Section ag ,Block , Lot I
CROSS STREET: t"Ct{`Y'1 L C�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential )( Non-Residential
DATE OF PREVIOUS PUMP-OUT: q (, hi°
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
RECEIVED -v .
Tow Clerk' •ffice
DATE: AUG 0 7 1987
Town Clerk SOtithOId
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