HomeMy WebLinkAboutBerdinka OFFICE OF THE TOWN CLERK c.\\CFO (1{;;
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ,,
P. O. Box 1179 cn
Southold, New York 11971 \ Q ' ,` •�
Telephone Tifo.(
(516) 765-1801 • -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK' or CESSPOOL
Operation Permit No. 597 Residential X
Fee $
10.00 Non-Residential
Septic Cesspool x
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NAME OF OWNER: John J. and Helen G. Berdinka
OWNER MAILING ADDRESS: 1280 Factory Avenue
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 1280 Factory Avenue
Mattituck, New York 11952
• OWNER TELEPHONE NUMBER: 516-298-8047
TAX MAP NO. : Section 142 Block 1 Lot 7
CROSS STREET: Sound Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Never previously pumped.
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Orif4614;eJu ith T. Ter
Southold Town Clerk
DATE: February 10. 1988 --
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•
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �VFo(,(r'�'= �q
Town of Southold CQ Application No. �
Judith T. Terry, Town Clerk k
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Town Hall, 53095 Main Road c �� ,u. `• . Residential X
P. O. Box_ 1179 ET,
��� Non-Residential
Southold, New York 11971 O � ,�0 �`
Telephone = 1 [ ',
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10 .'0
DATE January 27 , 1988
OWNER NAME: John J . Berdinka & Helen G. Berdinka
OWNER MAILING ADDRESS: 1280 Factory Avenue
Mattituck , NY 11952
OWNER PROPERTY ADDRESS: same as above
OWNER TELEPHONE NUMBER: 51 6-298-8047
TAX MAP NO. : Section------141.Q0 , Block 00 Lot 015 ,
CROSS STREET: Sound Avenue
TYPE OF SYSTEM: Septic Tank x New Existing x
Cesspool x New Existing x
Residential x Non-Residential
to the best of our knowledge , these
DATE OF PREVIOUS PUMP-OUT:
pools were never pumped before
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.)
Aj
Sipp
nature of Applicant
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RECEIVED BY:
Town Clerk's Office
DATE:
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