HomeMy WebLinkAboutZuhoski (3) SUPERVISOR ,,I�*OFF®i�
J�"AN W.COCHRAN �lI �® e®
COUNCILPERSONS t� ����� Town Hall, 53095 Main Road
t P.O. Box 1179
fr
ALICE J.HUSSIE t ® 7.n
JUSTICE LOUISA P.EVANS '; :''> -¢ ,_
` � t Southold,New York 11971
WILLIAM D.MOORE �` r T_ _ ����� Telephone(516) 765-1891
JOHN M.ROMANELLI ; %/ �® �� Fax(516) 765-1823
BRIAN G.MURPHY o°��
TOWN BOARD
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3758-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner _, _ ZUHOSKI, JOHN
Mailing Address 1 11825 OREGON ROAD
Mailing Address 2
City St Zip CUTCHOCUE NY 11935-0000
Property Address 1 11825 OREGON ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6887
Tax Map No. section 83.00 block 2 lot 14.000
Cross Street DEPOT LANE/COX LANE
Issue Date: 2/11/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF-THE TOWN CLERK ,,PFFD •�'
TOWN OFsouTHOI,1) ���� lj Application No. �� 7s
ELIZABETH A.NEVILLE,TOWN CLERK ',
.G � $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 a. ,,= *.$ $25.00 - Non-Residential
� ,app'�•' _
Telephone *e= 1 * '1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE �' —
OWNER NAME: > (2 /s / ' Fer17( /9S-S06)
OWNER MAILIN ADDRESS: I/ 9.02 3
N y I/ 93.5
OWNER PROPERTY ADDRESS:
_jp
OWNER TELEPHONE NUMBER: 9 .8 7
TAX MAP NO. : Section g"3 Block a Lot /3 , 7
CROSS STREET: .17,eppv-- t-,A,vE ----/
TYPE OF SYSTEM: Septic Tank New' C 'Existing
Cesspool ',fes 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.)
Signature, Applicant
RECEIVED BY:
Town Clerk s Office
DATE: '
•
t
•