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HomeMy WebLinkAboutZarzecki • JUDITH T. TERRY ` °••:2Town Hall, 53095 Main Road TOWN CLERK s 4 P.O. Box 1179 r t; Southold, New York 11971 REGISTRAR OF VITAL STATISTICS "„f MARRIAGE OFFICER � '� , :��� �i�` Fax (516) 765-1823 e .�� l�, Telephone (516) 765-1801 O Si OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1706-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner ZARZECKI, LOUIS Mailing Address 1 P. O. BOX 22 Mailing Address 2 City St Zip ORIENT NY 11957-0000 Property Address 1 170 OYSTERPOND LANE Property Address 2 City St Zip ORIENT NY 11957-0000 Owner Telephone No. 516-323-2464 Tax Map No. section 17.00 block 6 lot 11 .000 Cross Street MAIN ROAD (ROUTE 25) Date Of Last Pump Out 0/00/83 Issue Date: 6/13/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) P , J- Ili. OFFI E''OF THE TOWN CLER_ K �c31FOUr /, Town of Southold CQ Application No.// 41 Judith T. Terry, Town Clerk ‘ : - ' _ `I $10.00 - Residential Town Hall, 53095 Main Road -�:- rc P. 0. Box 1179 cr3 ? -- .- �' $25.00 - Non-Residential Southold, New York 11971 O Telephone el 0 , ( 16) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERAT ION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 7 7o2 Fee $ !/v . DATE 67/VQ / OWNER NAME: IO v 2a r 7. t2 G.k ; OWNER MAILING ADDRESS: P. O .. Bo )( .2._ ____.. Q 1^t..-e. R-E JA) 1/ ( / T S 7 OWNER" PROPERTY ADDRESS: / 470 - O / s f:_t_e-pe, r 4' it-4 , 0 r; ,e Y,T, iv Y OWNER TELEPHONE NUMBER: 676 - 3 ,-3 - c y 6 y TAX MAP NO. : Section ` 7 Block Lot 1/ CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Y Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: /973 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.) d--)6.....tAa....0- 3 6t..A.__6___e_d_....,h_t_‘ Signature of Applicant RECEIVED BY: _ � / . own Cl k's Offite DATE: Jo � 3 /� . , . � . -. ! • ` / . . � . _ '`` � � � .�- . / �_ ii:.:. . � ~/^�� , � ' / ` � �^ _�-_- -----_' ____ --_____ -_ __-___-- --- __�- _ � 3_ _ ______ __ ____ _ __ __--_ - ' �/ }� - � -_.....- "IMF __ _ _- __---______ ���12'*' �i'�-� x�^-~*� --_� �' _� _______ �. "wMF __ _____ _� "-� ____ ____ _ _____ _______________ � � __����_�� ___��������'� - --------�- _ '-----' -- ------------- - ----- -------------'----' ---� - --� / ` � /_� __- _-'_-_ ______'_-_ -'______- ___-__--___�' _ _� ------� -x,-r -- -- - --- '^ � _- __� . _ __-__ _ ___ --_ - _ -________- _____ - __ �� ~ �� ��-� [ 1� 7\� 8/ J / zl y� E Y�� /u �� / �� /� ��`' /v «J �� ' r /v � 1- ,.- __ _ -�~�-- . . _�_ �����. ,-: �_ _ iir±, 1viiI --- �------- ----- --- -- - --- -f ----- -- -' �- j ' ��- -----' " - '----- 4��-' °' _�_� T qr �~ 1-1 _ �_ _ - ____- __- .___-_��_-__-_-� � � ^ y� :1I1 = • • �u -` Lu '� -__ _ __. _-_- _ . _ -- ` ---'--- --- -- °= __________ - |--- --- ---- -c-h "/ ' � _ -_ - ,-- - ---- -- cn- ' -- --- - --- -- - - - ' - _ _ __' ________ ~ t4P [ uu ,�- - ----- ---- -- ~- -- ^^ ��'--i - -- '''-- ' \ 6 ^