HomeMy WebLinkAboutWiniarz OFFICE OF THE TOWN CLERK ,cs��FU1J(j
Town of Southold
Judith T. Terry, Town Clerk ' Z x' _
Town Hall, 53095 Main Road hFp'cc ,
P. O. Box 1179 `4
Southold, New York 11971 O `® ' ' - •�
Telephone s-40_ 1 ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 105 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
NAME OF OWNER: Cecylia Winiarz
OWNER MAILING ADDRESS: P.O. Box 1425
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Main Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8717
TAX MAP NO. : Section 140- Block 3 Lot 36
CROSS STREET: 160' West of Wickham Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: Sept. 1986
Judith T. Terry`
Southold Town Clerk
DATE: October 21 , 1986
(TOWN SEAL) • -\1
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OFFICE OF THE TOWN CLERK c5VFFU
Town of Southold &o C� Application No./10,5---
Judith T. Terry, Town Clerk '`
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Town Hall, 53095 Main Road � E Residential
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P. O. Box 1179 �����'� Non-Residential
Southold, New -York 11971 0 0y f° ��•`�
Telephone _0(
(516) 765-1801
TOWN OF SOUTHOLD _
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
RECEIVED
for
OCT 211986
OPERATION PERMIT
town Clerk Southold
SEPTIC TANK or CESSPOOL
Operation Permit No./a-5--
Fee
o/25Fee $
DATE O c� ° 14/ 191--4:-
OWNER
4f //OWNER NAME: ,E C-L1.4 tut ho'/,4/ Z-
OWNER MAILING ADDRESS: 144-iiti ' 0 ig®)(
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OWNER
s-2—
OWNER PROPERTY ADDRESS: ,/
OWNER TELEPHONE NUMBER: j ' (51'' 7/ 7
2/111°-3- 6.
TAX MAP NO. : Section Block Lot
CROSS STREET: /60 / WE'S'T O ai/Ci ,&-/4
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: //r-r lq. .5 I'! '�7 /fe
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.)
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/ Signature of AID. ic. • -
RECEIVED BY: d -e-7 _ ��� )
TownGClerk's Office
DATE: , �� /C�
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