HomeMy WebLinkAboutZuhoski (3) •
Town Hall, 53095 Main Road
t.
" P.O. Box 1179
, $� ,•'� Southold, New York 11971
�:•0 TELEPHONE
JUDITH T.TERRY 1" , ,�-
TOWN CLERK (516)7651801
REGISTRAR Oh VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 861-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ZUHOSKI, JOSEPH S.
Mailing Address 1 BOX 615, DEPOT LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 DEPOT LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6884
Tax Map No. section 96. 00 block 4 lot 6.000
Cross Street ROUTE 48
Date Of Last Pump Out 7/00/85
Issue Date: 9/27/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cSFFO(,'O'=
Town of Southold �Q eaG• Application No. O
Judith T. Terry, Town Clerk '� �'Civ ' - y
Town Hall, 53095 Main Road ~ "'`'' 'K" ',k -G 7 Residential
P. O. Box 1179 '�L.;? ; Non-Residential
Southold, New York 11971 %).. .•% �i
Telephone 1
fiye.'-'01
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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 $ /0
DATE P - ` fi'�
OWNER NAME: le-....1_,:
OWNER MAILING ADDRESS ,41 ath/
/'9 0
OWNER PROPERTY ADDRESS: O'22,2 _ �e-F,t _, . _
y.
IOWNER TELEPHONE NUMBER: 7 393 4 '89
TAX MAP NO. : Section q tp Block `( Lot dp
CROSS STREET: 60„,t sz , 42
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing `)(,
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1. 1 , - /9cr,�
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.)
9,4„,said
• it r ” e
if Sign Lure of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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