HomeMy WebLinkAboutWilcenski ,,,,,,,, iia,,,
JUDITH T. TERRY - Town Hall, 53095 Main Road
P.O. Box 1179
TOCLERK rt
REGISTRAR OF VITAL TATISTICS ,�� Southold, New York 11971
+
MARRIAGE OFFICER Fax (516) 765-1823
�' •
41
= �,�®� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3182-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner WILCENSKI, EDWARD
M-:I:.-..-. A.-1rld...-.. 1 D O 0(\V 717
Iv1UI1111y Iluu► eSS L
a'... Ca 7'._ AAnTTl rIIr'V kIV aInrn_t nnr
VILr JL LI'./
WW1 I III LI'..I IV I I IJJL-000U
Property Address 1 475 PACIFIC STREET
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5330
Tax Map No. section 141 .00 block 4 lot 16.000
Cross Street DEAST LEGION AVENUE
Issue Date: 3/07/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •cOFO(,-,,,-
Town of Southold �% - 4 Application No.3 / -
0� r <�I $10.00 - Residential
Judith T. Terry, Town Clerk x
Town Hall, 53095 Main Road o a 1
P. O. Box 1179 u' ft 9Z $25.00 - Non-Residential
Southold, New York 11971 O -1z4;�, ‘r se#6:13-44'
Telephone #6: 0 ..
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
AP 71. ?C;A-a!O i
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 44,11 - 111- 17/911
OWNER NAME: Cow Hf D V, Lc '7uf'
OWNER MAILING ADDRESS: • �� , —C' ,� d 6 S I,
PosT flic ` Dip! 4i-711 ,4 7-- -nit elf MAAi7-2-
OWNER PROPERTY ADDRESS: 41737 j -C..i-c d`c' ../---
d
ia--rr( Thick_k_ ! V W&---
OWNER TELEPHONE NUMBER: Jq g — -5-33 V
TAX MAP NO. : Section 'IT 3 A "1 Block 14i , ® Lf Lot Jl0
CROSS STREET: pin-c,.r(-,' 4 5f4 /S J Z. �l o /V
TYPE OF SYSTEM: Septic Tank ( - New Existing
Cesspool New Existing
Residential Non-Residential
1 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.)
, )_
. AQ-1/S- et/401/14-k
Signature of Applicant
,
RECEIVED BY: rj..//C-X2%---
Town
C:erk's Office
DATE: .7 /7 l
y •
__,. ... ,_ . . . .. s— , _ „• .-.....,—,. . ..-
. 4
. I (
.)
. A
II \ '
. ,
. r
\ , .
.../
. e)
. .-----6
,
's.
• -/ \---
r--,\
..1--, "' • -\--N\
, Ca ...<• 410 -r, C'''
--Ps- ••••••
"ON ,
(------r—
„._
s s.:
.-
-;
. ,
6-1 -1) ixl
,....
....,_ . .
,... ,
....) ..._,
..,...
, .
,.....a. . ,