HomeMy WebLinkAboutZelinski 41.
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Town Hall, 53095 Main Road
P.O. Box 1179
'" 04 ��� Southold, New York 11971
JUDITH T.TERRY ��'
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FAX ( 623
TOWN CLERK TELEPHONE
(5116)6)7 765-1801
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. 1246-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ZELINSKI, ALEX
Mailing Address 1 695 ALVAH'S LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 695 ALVAH'S LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6853
Tax Map No. section 109.00 block 1 lot 27.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/74
Issue Date: 9/21/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
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OFFICE OF THE TOWN CLERK Icv HU(
Town of Southold Q C0 Application No. /r�Jc�
4
•Judith T. Terry, Town Clerk y� �',
Town Hall, 53095 Main Road 7 $10.00 Residential
P. 0. Box 1179 cr) F ` ?: '�
�s- a� st,,, $25.00 - Non-Residential
Southold, New York 11971 O '� ' ''.o"
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
•
DATE /( /e7
OWNER NAME: flex •
OWNER MAILING ADDRESS: 05- 4 ) VGt. h Is
_ Irl 0 - U. - A • - ..
OWNER PROPERTY ADDRESS: .
OWNER TELEPHONE NUMBER: '7311- b O 5
TAX MAP NO. : Section /6 1 Block / Lot g '.7
CROSS STREET: p
�V ease_ 1-Vae
TYPE OF SYSTEM: frit New Existing 1
Cesspool 2- New Existing 2_
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
# ,
S •natur- of Applicant
RECEIVED BY:
VU
own Clerk's Office
DATE: 7 V?
v $ ,
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