HomeMy WebLinkAboutZlatninski 01.4.,T.TERRY � we
���� y< Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
ft, ,�` Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 1 Fax(516) 765-1823
MARRIAGE OFFICER ®�
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FREEDOM ORECORDS MANAGEMENT ��® a INFORMATION OFFICER = ,,,•���' p
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No. 3614-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner ZLATNINSKI
Mailing Address 1 C/O ELE DEVELOPMENT CORP.
Mailing Address 2 P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1715 GABRIELLA COURT
Property Address 2
City St Zip MATTITUCK NY 11935-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 108.00 block 4 lot 7.033
Cross Street ELIJAH'S LANE
Issue Date: 4/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ,cvFFO(.,(,„'=
Town of Southold N4 ' ea----: Application No.4.01, -'
Judith T. Terry, Town Clerk �� 1,� ~ ,•1' y
Town Hall, 53095 Main Road LO t _ 7 $10.00 - Residential
P. O. Box 1179 to *.'w yy ,,` �
Telephone ( i' $25.00 - Non-Residential
Southold, New York 11971 O`R 13% Ake - �`
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
,
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 4111 (9-÷-
OWNER NAME: 1 2--4-r1I n Z k I
OWNER MAILING ADDRESS: 1 7 is G , b121 a- I ( c. C+
ISI~-e_4"4—t C,i< ) N. '1 ( ( 9.5 2—
OWNER
OWNER PROPERTY ADDRESS: E i-r'Ct,C.
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 11:Y , Block q " Lot 7,3 3
CROSS STREET: a I i j‘ el h ' S Ln tO C
TYPE OF SYSTEM: Septic Tank 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.)
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RECEIVED BY:
Town Clerk's Office
DATE:
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"ELIJAHS LANE ES TA TES, SECT. 2
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s`° O SUFFOLK COUNTY, N Y.
,p 1000 - 108 - 04 - P/O 7. 1
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