HomeMy WebLinkAboutZuhoski (2) ft.,44%4°I C.t.P\1:7gli:4 I Clielet0...#:0,4;\
trld IN: , Town Hall, 53095 Main Road
V6giP.O. Box 1179
017.; Southold, New York 11971
JUDITH T.TERRY d FAX(516)765-1823
TOWN CLERK TELEPHONE(516)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. 1514-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ZUHOSKI, JEROME AND DEBORAH
Mailing Address 1 440 FREEMAN ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 440 FREEMAN ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5081
Tax Map No. section 139.00 block 3 lot 40.000
Cross Street CONKLIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 8/08/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i.
e -
OFFICE OF THE TOWN CLERK
Town of Southold i Application No. `V..
Judith T. Terry, Town Clerk % P�,- '`a y
Town Hall, 53095 Main Road Baa ' $10.00 - Residential
P. O. Box 1179 iw 4' k Nei ; $25.00 - Non-Residential
Southold, New York 11971 O °® , ii.:r - .,
Telephone _QI411 '
(516) 765-1801
MOND TOWN OF SOUTHOLD
JUN 2 9 WO SOUTHOLD WASTEWATER DISPOSAL DISTRICT
ion Qat' EgAd
APPLICATION
for
•
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0. 00
DATE 6- i.-90
OWNER NAME: �J LE c.n,e t ,Se-6p, A 2ukio.sic,.‘ '
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OWNER MAILING ADDRESS: */o em / /2d-4e-
/»✓g- ii''*x_k. /0y //75-3.---
OWNER
5-:--OWNER PROPERTY ADDRESS: @,OYle. C - rm- -40'a�j
• OWNER TELEPHONE NUMBER: a9 -57J /
,
TAX MAP NO. : Section 13 ? Block 3 Lot,,- /(
CROSS STREET: g,c},Li i Rve_ hiA--4fr-be / 1.)Y //y5-1®
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: T�s-7 4-rme evel'cy.e Q/,Si` 1c e vP— achse pf' Ad�-rie-?-u
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.)
ded.-Signat a of Applicant
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RECEIVED BY: OC/die-----------
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i•wn Clerk's Office
DATE: g , 7470 .
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"_ • • .4.1.;,4 ...'tP -.N;: 765-1802 9 AM '0 : PM FOR THE
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