HomeMy WebLinkAboutZukas c
ar ' Town Hall, 53095 Main Road
� �`� P.O. Box 1179
®.0 Southold, New York 11971
JUDITH T.TERRY ® 00 S 6L PHONE
FOWN CLERK )
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. 824-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner ZUKAS, GRACE & WILLIAM
Mailing Address 1 265 HUMMEL AVENUE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 265 HUMMEL AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2267
Tax Map No. section 63.00 block 2 lot 15 .000
Cross Street YOUNGS AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 9/09/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c�IFO(,��'-
Town of Southold Q � rl'OG�: Application No.1 8a
Judith T. Terry, Town Clerk fi As A- "•.,�
Town Hall, 53095 Main Road ; F .- I Residential
P. O. Box 11790 �
� z ,rv`.rso ` Non-Residential
Southold, New York 11971 ® ' O�•�
Telephone0,�' •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL •
Operation Permit No. Eo2
Fee $ /O..
1 DATE -��
OWNER NAME: /'
q(y it Lam-AO
��
OWNER MAILING ADERESS:, % �` /L 1/ „ ,1 A-4
l ti? 71
OWNER PROPERTY ADDRESS: 7'(t
OWNER TELEPHONE NUMBER: •/‘ 76,E ��
TAX MAP NO. : Section Block Lot
CROSS STREET: f 4i h/q`S
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 1> New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 9 .1F ®U 7
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.)
7-7,, `44‘
Signature of Vicant
RECEIVED BY: •44417,801411
i801411
To , n Cl' rk's 1r7ice
DATE:
9/9/1?
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