HomeMy WebLinkAboutZeneski OFFICE OF THE TOWN CLERK ' .C3f ebi;f‘�`
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road -
P. O. Box 1179 � �_�3'�` •
Southold, New York 11971
Telephone .( N.a0 I
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 47 Residential XX
Non-Residential
• Fee $ 10.00
Septic Cesspool Xx
NAME OF OWNER: Althea Zeneski
OWNER MAILING ADDRESS: P.O. Box 125
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: Eugene Road
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-6827
TAX MAP NO. : Section 97 Block 8 Lot 9.1
CROSS STREET: Little Neck Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 11, 1986
Judith T. Terry D'
Southold Town Clerk
DATE: September 17, 1986
(TOWN,)SEAL)
OFFICE OF THE TOWN CLERK �FFDCA/
Town of Southold rs% , CSG' Application No. /
Judith T. Terry, Town Clerk < I Residential
Town Hall, 53095 Main Road _,
P. O. Box 1179 v' ' Non-Residential
Southold, New York 119714 ® K t . •,�
Telephone : .�
,'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 47
Fee $ •
DATE
OWNER NAME:
OWNER MAILING ADDRESS: -p ta6
" 119 t
OWNER PROPERTY ADDRESS: -6.12,-)t,,
y .4 e
OWNER TELEPHONE NUMBER: 7 1/ - 0• 7
TAX MAP NO. : Section 9/7 Block 6 Lot
CROSS STREET: ``��,,/,( .'f,9xtiL er.,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7 -- //- to
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.)
Sig .t e of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
6
I e
� J
1
4140
W
p-L0,4
A
JJ