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OFFICE OF THE TOWN OLJ
Town of Southold o���_ C�!/
Judith T. Terry, Town Clerk
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Town Hall, 53095 Main Road aMX
P. O. Box 1179 •�•
Southold, New York 11971
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Telephone = ®1 41 -*
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 234 Residential X
Non-Residential
Fee $' 10.00
Septic Cesspool x
NAME OF OWNER: John J. Zuhoski Sr.
OWNER MAILING ADDRESS: Grathwohl Road
Cutchogue_. New York 119351
OWNER PROPERTY ADDRESS: Grathwohl Road
New Suffolk, New York
OWNER TELEPHONE NUMBER: 516-734-6153
TAX-MAP NO. :, Section 117 Block 4 Lot 7
CROSS STREET: New Suffolk Avenue
TYPE OF SYSTEM: Septic Tank X New Existing x
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: February 1984
Judith T. Terry
Southold Town Clerk
DATE: March 9, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK COFO( r"
Town of Southold Application Nog-
Judith T. Terry, Town Clerk
Town Hall 53095 Main Road Residential
P. O. Box 1179cn , R : Non-Residential
Southold, 'Nev.; York 11971 °be `in
_0�.�'
Telephone : .0 N , e
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. dZ3 y
Fee $
,DATE )e-�J. �.. /9 F/
OWNER NAME: john Zc. ukcs1C.. fir .
OWNER MAILING ADDRESS: Cro A--k (.�0 k 1 Road
OWNER PROPERTY ADDRESS: -c 4 - 4 I k gar(
Ne (-A) ��� �' o( IC, Iv Q °
OWNER TELEPHONE NUMBER: 3 j-- (, 3
,TAX `MAP NO. : Section / / 7 Block # 1-/- Lot '
CROSS STREET: C
TYPE OF SYSTEM: Septic Tank , - New Existing
Cesspool New Existing
Residential ,/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: /98
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.)
/Lc J. 6C- A
Signatureof Applicant
RECEIVED BY: G e-O-r gtec�
Town Ierk's ffice
DATE: �Y�C�/L Glc- 7 rel
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