HomeMy WebLinkAboutBabashak Y
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`-��- � Town Hall, 53
095 Main Road
%1 / O ®`'V•4r P.O. Box 1179
,Y $Y_Yrir Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1117-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BABASHAK, JOHN F. AND LAURA
Mailing Address 1 P. O. BOX 645
Mailing Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 3500 GRATHWOHL ROAD
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-734-5647
Tax Map No. section 110.00 block 8 lot 4.000
Cross Street NEW SUFFOLK ROAD & WICKS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 5/22/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'S�FrFOCA- ' /�J
Town of Southold �� CQG; Application No. ��(
11
Judith T. Terry, Town Clerk % V iii - y
Town Hall, 53095 Main Road ; ' ,,...."::,:w . 7 Residential
P. 0. Box 1179 crs ligi. Elle, . . Non-Residential
Southold, New York 11971 O ® ..,. . ®� ���
Telephone 0 iii �P .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ (O a oo .
1
DATE a 1(:: 49
1
OWNER NAME: �G h,J r, 6A) Lqsj-nL 1.�O V/.A 610b51-Kik
OWNER MAILING ADDRESS: p. O , 6...,, [ /5
AkAw 5u-1; /kJ iv, y. Ms-6
()INNER PROPERTY ADDRESS: -g/-, Wo) .-
A)€i I 5U / pi, Y /,/
OWNER TELEPHONE NUMBER: 616 - 731/- SZ 7
TAX MAP NO. : Section / ( 0 Block Lot 6
CROSS STREET: �7e4we-�,J MAA/ 54-OL Riad' 9Ce
` IA/ -C P--0 �
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Jp_,,l(, '6/c”
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.)
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Signa re of Applicant
RECEIVED BY:
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TOIVN OF SOUTUOLD , N.y.
GUA7,ANTEED TO TUE TITLE Gl1AKANTEE
COMPANY 0 SURVEYED • AUG. 19, 1969
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