HomeMy WebLinkAboutZaleski •
OFFICE OF THE TOWN CLERK FU
Town of Southold ; ��� OLA-e,:
Judith T. Terry, Town Clerk � ��4 ' �-
Town Hall, 53095 Main Road
P. O. Box 1179 ts3
® : ;` •,
Southold, New York 11971 � Q
Telephone ^ �(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 180 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Wesley Zaleski, Sr.
OWNER MAILING ADDRESS: Bayview Road
Southold, New York 11971
OWNER PROPERTY ADDRESS: Bayview Road
Southold, New Yo rk
OWNER TELEPHONE NUMBER: 516-765-2185
TAX MAP NO. : Section 70 Block 7 Lot 20
CROSS STREET: Clearview Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: unknown
•
Judith T. Terr
Southold Town Clerk
DATE: December 16, 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •• " �FFO •
Town of Southold ���_ .Faire,"
Application No./(g)
Judith T. Terry, Town Clerk `rte
Town Hall, 53095 Main Road Residential
Residential
P. O. Box 1179 z Non-Residential
Southold, New York 11971 O /�` -
Telephone : 1
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for '
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /ft
Fee VC
DATE t a.l i..51 8- 4,
OWNER NAME: [o e y Z. i L c s k l te
OWNER MAILING ADDRESS: 6 y V t r,} 1 c d
L.2.)-j- o L l,� . 11 9 7 J
OWNER PROPERTY ADDRESS: • S .A-J1 N.
OWNER TELEPHONE NUMBER: 7 6 5 -
TAX MAP NO. : Section °1 o Block 7 Lot A-®
CROSS STREET:
TYPE OF SYSTEM: Septic. Tank New Existing
Cesspool ✓ New Existing
Residential 'Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.) -
Lic2
( 4eo pp is t��.
RECEIVED BY: CVc(c---//c
Recol;.') n C rk's Off ce
DATE: DEC 16 26
town Clerk Southold
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