HomeMy WebLinkAboutZuhoski ruLCn
Si 8 O •'
n.p��d � �SJ �.ia�5� ':..
` !i' �t" , r' Town Hall, 53095 Main Road
‘EC:#
- ,,.tt?--.`i,MFM,
o, P.O. Box 1179
=PAd Southold, New York 11971
JUDITH T.TERRY -Am/ TELEPHONE(5 6)765 1801
TOWN CLERK
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. 1022-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ZUHOSKI, EDWARD A., JR.
Mailing Address 1 ROUTE 48
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 ROUTE 48
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6587
Tax Map No. section 96.00 block 4 lot 1 .000
Cross Street DEPOT LANE
Date Of Last Pump Out 0/00/87
.' '' /.5"."41w skigae,-...
Issue Date: 2/15/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK •0 -4-E9-:.--:.
y
Town of Southold %�: C'QG', Application No. -
Judith T. Terry, Town Clerk �° y -; y
� � W,� v� , � 1 � Residential
Town Hall, 53095 Main Road a .
O ' " j'° "f" Non-Residential
P. O. Box 1179 �' � tw ��
Southold, New York 11971 O� ® *' >-0-��`�
Telephone ( ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE D..,,, 9 -
• OWNER NAME: • ___ _,,j--klao ,--k
OWNER MAILING ADDRESS: 1
OWNER PROPERTY ADDRESS: 14
II
__1241,,,E1,_‘6me.,
2--ytiz
OWNER TELEPHONE NUMBER: '-'7 2-1 — (,pg g _I
.
TAX MAP NO. : Section Block C( (o, ---1--) -- (Lot •
CROSS STREET: rh cY .
TYPE OF SYSTEM: Septic Tank / New Existing •
Cesspool • ------
New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ) 1 8-'?
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
P6--&-Q . _ of distance, approximately, to building and closest road.)
1 Ts---0 1 w-^N 'L. CA:'- ° — & t C----e------- a?
C2
Signatur o Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
•
7