HomeMy WebLinkAboutBegora OFFICE OF THE TOWN CLERK =-', VTFU(/((`+'
Town of Southold
Judith T. Terry, Town Clerk �� •max>" 'r` '
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Town Hall, 53095 Main Road
P. O. Box 1179 . ,
Southold, New York 11971
Telephone _ jig 1%
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 99 Residential XX
Fee $ 10.00 Non-Residential
Septic Cesspool XX
NAME OF OWNER: Frank and Ethel Begora
OWNER MAILING ADDRESS: Main Road
East Marion, New York 11939
OWNER PROPERTY ADDRESS: Main Road
East Marion, New YOrk
OWNER TELEPHONE NUMBER: 516-477-1796
TAX MAP NO. : Section 31 Block 4 Lot 19
CROSS STREET: Stars Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential XX Non-Residential
DATE OF PREVIOUS PUMP-OUT: September 10. 1986
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Judith T. Ter
Southold Town Clerk
DATE: October 20, 1986
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(TOWN SEAL) -
OFFICE OF THE TOWN CLERK C-35FU(tCQ
Town of Southold �� �. G'� Application
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road '''" t �G Residential i/
P. 0. Box 1179 L(723 -4 �; Non-Residential
Southold, New York 11971 O ® O� .�
Telephone 4*0.( , s" .°.
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(516) 765-1801
TOWN OF SOUTHOLD
C�IV�l SOUTHOLD WASTEWATER DISPOSAL DISTRICT
REOCT 2 u 1986 APPLICATION
irnm r'!,!rlc Southold for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.9
Fee $
DATE /0/ E° %YG
OWNER NAME: F IJVe 9CC.pk lc (- ate( Rv%4'7
OWNER MAILING ADDRESS: , Rd) /-Mai tf/ .s9"
OWNER PROPERTY ADDRESS: 24.441R--
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OWNER TELEPHONE NUMBER: , Y- 44774796
796
TAX MAP NO. : Section 3)-1-/- 19 Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool t..-7" New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: �f /0/0
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.)
Signatur°e of Applicant
RECEIVED BY: cc
Town Clerk's Office
DATE: CJ�`_Y_J. c.2e.) , /sX
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