HomeMy WebLinkAboutCzujko �$®®�13FFO`it
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JUDITH T.TERRY < Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
w n � Southold,New York 11971
REGISTRAR,OF VITAL STATISTICSy ��,�I� Fax(516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER �?�elskit `��010 Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3516-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner CZUJKO, ZENON
Mailing Address 1 1945 DEEP HOLE DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1945 DEEP HOLE DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4725
Tax Map No. section 115.00 block 14 lot 17.000
Cross Street RICHARDS STREET
Issue Date: 9/27/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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011 np.
OFFICE OF THE TOWN CLERK CO Fitt(
Town of SoutholdCQG?, Application No.
Judith T. Terry, Town Clerk
53095 Main Road $10.00 - Residential
Town Hall, � c
P. O. Box 1179u' ,•,;; .• ,ti` „ ' tri �' $25.00 - Non-Residential
Southold, New York 11971 O` �
Telephone _®.( � •�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No.
Fee $
DATE ,Q�,,J'- g-3, ( `a 5 Y,
OWNER NAME: `
OWNER MAILING ADDRESS: jg45 b C CT I ,� I) .1 i
,M A 7-i' i- -R , i I
OWNER PROPERTY ADDRESS :j t be-E-6> 14-gLe
OWNER TELEPHONE NUMBER: ,,9V - L/7 L 5 •
V73`d'W 9
TAX MAP NO. : Section lig- Block / Lot / 7
CROSS STREET: a►ca-4Aio55 `6T e _
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ,< New Existing
Residential X.
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.)
I
a. ice.
% Se of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
MAP OF DEEP HOLE CREEK ESTATES '
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300.00'TO RICHARD STREET-'• N 30° 11'20"W 120.00' MAP OF LAND LOCATED AT
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TOWN OF SOUTHOLD COUNTY OF SUFFOLK
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+ ISURVEYED FOR
' t DEEP HOLE I DRIVE ZEON CZUJ KO
/J 1+�g C7UT Z _ DATE: 3 2 I 66
t GEORG H. LJ I" = 20' N
FINAL LOCATION 6 - 22- 66 ROCKY PoIN1,N.Y "L
'E 0.--STAKE ® =MONUMENT ' FOUNDATION LOCATION 4 - 16 - 66 LICENSLL LAND SURVEYOR C 5 i(