HomeMy WebLinkAboutZapkus •
OFFICE OF THE TOWN CLERK 6 'cgfOU-C"
Town of Southold �Q ��
Judith T. Terry, Town Clerk 11 ,_` 7,1&:(41.1.
Town Hall, 53095 Main Road 1 ' !XI
"
P. O. Box 1179 C� n044 Southold, New York 11971 p "® �-Telephone 14#0/ "(516) `765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or' CESSPOOL
Operation Permit No. 418 Residential X
Fee $ 10.00 - Non-Residential
Septic Cesspool X
NAME OF OWNER: Kestutis Zapkus and Jerry Gambone _
OWNER MAILING ADDRESS: 4860 Rocky Point Road '
East Marion, New York 11939
OWNER PROPERTY ADDRESS: 4860 Rocky Point Road
East Marion, New York 11939 -
OWNER TELEPHONE NUMBER: 516-477-1341
TAX MAP NO. : Section 21 Block; 3 Lot 23
CROSS STREET: Southern Blvd. and Aquaview Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Never previously pumped.
Southold Town CI r� k
•
•
DATE: -Auqust,28, 1987 -
(TOWN SEAL)
®- „. sem- , '.
II IIS
OFFICE OF THE TOWN CLERK c31Fair
Town of Southold Oho %.;.- Application No. V./4V
Judith T. Terry, Town Clerk �`=,''',, ��'� Residential
Town Hall, 53095 Main Road c ,-'''''',Y10, -
P. O. Box 1179 u-' ' .' Non-Residential
Southold, New York 11971 OS
Telephone ®.( ��
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ \O,0®
DATE P 1 \3 YCV>
OWNER NAME: IF>=ST'1t\S 2 k $ A- J ei-R4 el -AA-bc E
OWNER MAILING ADDRESS: °'k 1 O Q�pC VZSI �4i2 (`�
a• KPr2`a� t P,<-1), . \\..0139
• OWNER PROPERTY ADDRESS: Pk--IU`&
OWNER TELEPHONE NUMBER:S ' —— ‘..1 4
TAX MAP NO. : Section pt t Block 'l. Lot a-3
CROSS STREET: '-c -1',re . je_es.' Sa 4-1-) `�\v0, P %uletvle,-,, rb(i',
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool y- New Existing '
Residential )- Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1P3ei), -- cMS
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.)
14,r- Friijhe,
u e of Applicant
SiSI
LA*44''
RECEIVED BY: ?AAA(‘' 6-
Town Clerk's Office
DATE:
6-700, 8a.NE
Loc_A---C: PSP ; (kw
&A-s-T /--AA-72.Z dti N vk ,
a _ 161
O '74) e•0
4