HomeMy WebLinkAboutZaneski {'L'r
Town Hall, 53095 Main Road
, tz. P.O. Box 1179
rs-2 0;0' Southold, New York 11971
JUDITH T.TERRY �1 FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1375-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ZANESKI, ANNE H.
Mailing Address 1 2475 GRAND AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2475 GRAND AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
•
Owner Telephone No. 516-298-8660
Tax Map No. section 107.00 block 8 lot 39.000
Cross Street WESTVIEW DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 2/01/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �c�VFF�(,� '7
Town of Southold C'� '- Application No. /`3
Judith T. Terry, Town Clerk � , t'a, y
..,�:f .0 l $10.00 - Residential
Town Hall, 53095 Main Road � ''^ '" ;:X
P. O. Box 1179 cn � $25.00 - Non-Residential
Southold, New York 11971 O ® asJ '~ /J
Telephone �j ,�•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
PATE
• OWNER NAME: 4 ' S K � •
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OWNER MAILING ADDRESS: 07 6 R4-kJd 4-U'e
Pi A-4rT r.( C� N y , / / f c2-- -
OWNER PROPERTY ADDRESS: fykr /4
OWNER TELEPHONE NUMBER: ( / Y9 - K G
TAX MAP NO. : Section / d l Block d" Lot 3
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New _Existing
Cesspool New Existing
Residential / Non-Residential
DATE OF PREVIOUS PUMP-OUT: 11/5yr?
LOCATION MAP: Must be attached hereto beforepermit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Signa re of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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/ 10 us €—
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