HomeMy WebLinkAboutWiniarz (2) SAP( lal
Town Hall, 53095 Main Road
y® - �$ P.O. Box 1179
' /®1 .�1�® � Southold, New York 11971
JUDITH T.TERRY 411 I,, TELEPHONE
TOWN CLERK (516) 765-1801
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. 666-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner WINIARZ, MECISLAUS
Mailing Address 1 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952-0000
Property Address 1 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8140
Tax Map No. section 114. 00 block 11 lot 26.000
Cross Street REEVE AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 4/05/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/� • Ie. _
OFFK E" OF THE TOWN CLERK c��FFair
Town of Southold Application No.
0��
Judith T. Terry, Town Clerk 4-404
Town Hall, 53095 Main Road ;` Y :G Residential
P. O. Box 1179 -TAYui z Non-Residential
Southold, New York 11971
Telephone -.1:61-1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /O
DATE y/./(52-tg—
OWNER NAME: , /t(V., S (WW/4-ie z—
OWNER MAILING ADDRESS: ,A/BC4I SPPPCICX A
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OWNER PROPERTY ADDRESS: � /l✓f/�
OWNER TELEPHONE NUMBER: • cC "- ( 2-/Y
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /( /, RC
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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ignature of Applicant
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RECEIVED B • t�/•14.,.._O
"''own J7 rk's Of lice
DATE: APR 0 51988
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