HomeMy WebLinkAboutZazecki y 0• „,
ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK c +.c P.O. Box 1179
t C Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ;0 Fax(516) 765-1823
MARRIAGE OFFICER 1
RECORDS MANAGEMENT OFFICER '4fo, %O.° Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER a"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3832-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner ZAZECKI, JOHN
Mailing Address 1 48400 MAIN ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 48400 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 70.00 block 7 lot 13.000
Cross Street
Issue Date: 11/27/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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' ) CE OF THE TOWN CLERK .C31
TOWN
TOWN OFSOUI'HOLll 14% Application No. 3`e 3
ELIZABETH A.NEVILLE,TOWN CLERK C'1 $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971
$25.00 - Non-Residential
Telephone OI 4( 0"/
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
RECEnirrt
OPERATION PERMIT NOV 2 7 1998
SEPTIC TANK or CESSPOOL
[own Clerk Southold
Operation Permit No.
Fee $ •
DATE 11r - a S' 8
OWNER NAME: 0-0 ,v A Z
OWNER MAILING ADDRESS: 4 $ '0O f-1 /9- / &)
R 1�
--So uOrb y 117 -11
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER:
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TAX MAP NO. : Section 70 Block .7 Lot /3
CROSS STREET:
TYPE OF SYSTEM: Septic Tank P.V New Existing
Cesspool New Existing
Residential ✓ Non-Residential
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.)
t
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Signature of Applicant
RECEIVED BY:--41 -Ci
n Clerk's Office
DATE: Illa7(gg/
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