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Home My WebLink AboutAndrejack MOM ,,1141 • i Town Hall, 53095 Main Road jc�® �� P.O. Box 1179 07i Southold, New York 11971 JUDITH T.TERRY t`'41s_� 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. 3580-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner ANDREJACK, JOSEPH T. & SUZANNE Mailing Address 1 P. O. BOX 1682 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 1305 LIGHTHOUSE ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-1701 Tax Map No. section 50.00 block 6 lot 5.009 Cross Street SOUNDVIEW AVENUE Issue Date: 2/05/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) / ..� OFFICE OF THE TOWN CLERK 'OFOU e,- Town of Southold � CQ ' Application No. 3 SFs6 Judith T. Terry, Town Clerk � � :l Town Hall, 53095 Main Road . - $10.00 - Residential s= P. O. Box 1179 N h�i,�; $25.00 - Non-Residential Southold, New York 11971 O � Telephone j (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT i CAT IOP for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE OWNER NAME: Uoph 1. a Suzanne iql)(lrre ac/ OWNER MAILING ADDRESS: P.1). Om( l(o c-So u4ho1d IU 103.1 OWNER ,PROPERTY ADDRESS: 1305 titch oust 1 ocLO &u`1'1' o le 11q4-1 OWNER TELEPHONE NUMBER: ,5111 465 I1-01 • TAX MAP NO. : Section 51) , Block 1.0 Lot Pio 5- CROSS CROSS STREET: UQUY1dViatc) Ilvtn1 u, TYPE OF SYSTEM: Septic Tank New Existing Cesspool New .% Existing Residential ✓ 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.) dulmotealY1 Signature of pplicant RECEIVED BY: Town Clerk's Office DATE: P_//e/c7� -...-2 ,--i•-----,ii,-rv--.-:, ...,,,,,w,,,,,,,,,-0,-,-;•,,-,- -1...;•-!,:..-- ---- ''.4,'''''' ',.,, ''',....'''' ,1C-,-', .'' ' ,-,' -.'-' '''''' 'IT', .r -: ' '' ':: :,':,''-: ':,..an......?./ 7‘,1171474WIP71.. .',.12, ...';s2:-..-%:.;'41 ' ''.•::'1..!';: "-1-_r "'].-,:'2..., 1,'.2, ' n lb' ris. ,,-',' --l';?- .-v:A.,:,' •'/-9,-,--,' --Q.; 1.--,;•..;.,- ,.'-,-' "-.,-',', -:-7,:-..r..-,., -,:',.','';•-,„, ,-„,,,,-'. ,,.,—-,-.. -- - ,-,-,,, • ,,-.',.. -:',;,-,,.... ,cof-Q,s•,,i, ,„ ., - .. ,,"1,-.--:1. ,.,;‘,A-r'•' :,1. 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