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OFFICE OF THE TOWN CLERk c,0FUU'`,-
Town of Southold �Oa0�
Judith T. Terry, Town Clerk , ••
Town Hall, 53095 Main RoadcZV*
P. O. Box 1179 . 0, 4
Southold, New York 11971 O ' "" , : `�:. �-
Telephone ad, �.a0-/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. Residential XXX
Fee $ 10 . 00 Non-Residential
Septic Cesspool XXX
PERMIT ISSUED TO:
NAME: ALLEN W. OVSIANIK
ADDRESS: P .O . BOX 485
CUTCHOGUE . NEW YORK 11935
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
NEW SYSTEM
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION: -
OWNER OF PROPERTY: Allen W. 0vsianik
OWNER MAILING ADDRESS: p .o . Box 485
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: Soundview Avenue
Southold, New York 11971
TAX MAP NO. : Section 059 Block . 7 Lot 29 . 4
CROSS STREET: Kenny ' s Road
BUILDING PERMIT NUMBER CROSS REFERENCE: #15153
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Judith T. Terry /
Southold Town Clerk
DATE : August 11 , 1986 ` '� �'
•_ (TOWN'SEAL)\
- ,' '
14,y' V�, '`
�3/ --�,� Town Hall, 53095 Main Road
=. ,, .. �-+� P.O. Box 728
`°I Southold, New York 11971
JUDITH T.TERRY 4.4.".•i•i/•0° TELEPHONE
TOWN CLERK
(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To : Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. for a
CONSTRUCTION or ALTERATION Permit for a cespool or septic system
submitted by [�i��� G(,) �h;� •
Please advise if the project has received Suffolk County Health
Department approval and if we may issue the permit .
A--/tre/CtA-e„.
/1/1% ,/ftJudith T. Terry
Southold Town Clerk
Attachments
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is
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk Application No.
Town Hall, 53095 Main Road Construction
P. 0. Box 1179
Southold, New York 11971 Alteration
Telephone Residential v
r"`' "`...'°"' ► Residential
TOWN CLERK
TOWN OF SOUTHOLD y
Suffolk County, New York 516 - 765-1801 N9 19 4 4 8
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t1iold, N. Y. 11971L.2. , a9/ 191
!REC VED OF, (
ab Dollars
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Judith T. Terry, Town Clerk
Cash ❑ Check �Q lly—� ���°:. . ,
®Daae
Permit No.
Fee $ /0_,90
DATE D —I^gb
APPLICANT NAME: (. • OV.5,141.-r;
APPLICANT ADDRESS: , � i'- rbc
Cttit�c 1. 1/4.-1/4.- �1/
33"
SEPTIC • CESSPOOL /
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
KE'er v56' / Si��Y
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF-PROPOSED CONSTJUCTION OR ALTERATION:
OWNER OF PROPERTY: ,, 6z6)-( w.
OWNER MAILING ADDRESS: Rcn� C1 S,
c,<c h9,( - _ 1/53_3- -
OWNER PROPERTY ADDRESS: 1/i�� t!E'-
Sbv7-40 `fir . , //,7/
TELEPHONE, NUMBER OF CONTACT PERSON: 7J/ a/o
TAX MAP NO. : Section i29 Block 7 Lot a29
CROSS STREET: ftp ,,,All('5 /0;.)_.4.
BUILDING PERMIT NUMBER CROSS REFERENCE: JS/S3
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Signat a of Applicant
RECEIVED BY: . �`4 /
Torn Clerk's office
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