HomeMy WebLinkAboutZaneski tri Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY
-� �rr .r�rTELEPHONE
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. 688-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ZANESKI, FRANK
Mailing Address 1 BOX 448
Mailing Address 2 FACTORY AVENUE
City St Zip MATTITUCK NY 11952-0000
Property Address 1 FACTORY AVENUE
Property Address 2
City St Zip MATTITUCK- NY 11952-0000
Owner Telephone No. 516-298-8083
Tax Map No. section 122. 00 block 2 lot 20. 000
Cross Street SOUND AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 5/03/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
. .
OFFICE OF THE TOWN CLERK ,CiFFillj(•'•
Town of Southold Application No. V �
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road c ` ,f "� } Residential
P. O. Box 1179 . Non-Residential
Southold, New York 11971 ® ®ticZ
Telephone
P.i �
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 2. `eY
OWNER NAME: Z'79.4,ES
OWNER MAILING ADDRESS: c___tG/' 1/ 2� Wff
#7-74 jig // s-
, OWNER PROPERTY ADDRESS: 'h2,P9 E ,s•
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 1 ,9-, Block er Lot c,10
CROSS STREET: -u-�"
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool - New Existing
Residential t" Non-Residential
DATE OF PREVIOUS PUMP-OUT: , ) jz1-nalr .1J 1.11L*,
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.)
Signature f Applicant
RECEIVED BY:
Tow c 4r1- 1-sWce
REC
DATE:
MO 0-31999
a
down Clerk Southold
fI4-C t4 fe,/ f'U 6.►
I
j ,
HoLSL 1
b .
\ : g
i io ,r-fie, I
1 , ,./- (i
/04;
\6) ,j,s5f.,).