HomeMy WebLinkAboutBugdin 001fak --
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= � Town Hall, 53095 Main Road
t. V'p �- ��` P.O. Box 1179
®e A `a®i� Southold, New York 11971
JUDITH T.TERRY
..,i///i#I0 TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 705-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner BUGDIN, JOSEPH
Mailing Address 1 CARROLL AVENUE
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 MINNEHAHA BLVD.
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2488
Tax Map No. section 87 . 00 block 3 lot 5. 000
Cross Street OWASSA AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 5/17/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �S�FFO(,��''-
Town of Southold � ,.q CQG Application No. 7...0
Judith T. Terry, Town Clerk % y
Town Hall, 53095 Main Road o ` '4 '� 7 Residential
P. O. Box 117951 , �,� ��� Non-Residential
Southold, New York 11971 O, ®� 4 ._ O��J
Telephone ` 0.(4 `'1 '°
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. PZO'
Fee $ l(0 •�
DATES/1119
OWNER NAME: Jp1) RI Gd ( :V
OWNER MAILING ADDRESS: CORP o 1 i ve_, , •
PEccfYi'cf.,/ 1 . Sj9r ?
OWNER PROPERTY ADDRESS: F im( iNho e_ 6( rA-61 6i- L )f)
OWNER TELEPHONE NUMBER:r7 Block
5 - ii-ss
TAX MAP NO. : Section r c Block J Lot g
CROSS STREET: 0 (,J F} 5S1 69-U e-
TYPE OF SYSTEM: , Septic Tank New Existing
Cesspool New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7 J 'd' lO�c.r}-a�/}n)
3
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.)
2 1C C
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GSigna ure of Applickult
RECEIVED BY: O -' - c-
R tT wn Clerlt's Officf
DATE: MAY 1-71988 •
Ion Clore Southold .
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