HomeMy WebLinkAboutBialeski OFFICE OF THE TOWN CLERK ' 'c0FOU(i►.
Town of Southold �G
Judith T. Terry, Town Clerk Z : tk
Town Hall, 53095 Main Road c f {; fk ,
P. 0. Box 1179 i, cn we,t, ,e4M.:t;
Southold, New York 11971
Telephone .( i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER D SPOS.4L DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 454 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Felix W. and Anne Bialeski
OWNER MAILING ADDRESS: P.O. Box 678
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Main Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-8072
TAX MAP NO. : Section 115 Block 1 Lot 4
CROSS STREET: Village Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Judith T. Ter
Southold Town Clerk
DATE: October 8, 1987:
(TOWN` SEAL)
IIS
OFFICE OF THE TOWN CLERK c0Filtir7
Town of Southold �� .- CQ ': AApplication No. 2714.5-11Judith T. Terry, Town Clerk Residential o!
Town Hall, 53095 Main Road ` ''
P. O. Box 1179 tr' ;» sr �' Non-Residential
Southold, New York 11971
Telephone ®.1 zirts , • 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
m
Fee $ l(A
DATE
. % 2 /G�/�.S/1 7
OWNER NAME: --P-..e.- //y U� 9LrI
OWNER MAILING ADDRESS: $060 /3D/ 6/7(
/u)/
OWNER PROPERTY ADDRESS: -77)/9",,0 )4 4
/)�/ -1L/ - -a
OWNER TELEPHONE NUMBER: 29S !'i ?
TAX MAP NO. : Section / /5- Block / Lot V
CROSS STREET: � � � °72-rcR�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool .✓ New Existing /
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: (,),(Ae c /9117
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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Signature of Applicant
RECEIVED BY: � � _ ,
Town f rk's Of rice
DATE: OCTO8
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Town Clad &NNh4k
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C ,.7 Q "` 07 Q JNAUTHORIZED ALTERATION OR ADDITION
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SECTION 7269 CF ThE NEV/ YCRK STATE
EDUCATION LAW,
• 1 GOPICS OF if115 SJ^1';y,x,1An NOT BEARING
012- A THE LAND SU;VCY,;•� , .D S-
• EMBOFS:D Sfq: c'•. L. 'AL OR
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TUE,C r�•a'r `'•DlldG INS71-