HomeMy WebLinkAboutBolobanic •
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V?„ h Town Hall 53095 Main Road
TY; /r P.O. Box 1179
���!' Southold, New York 11971
JUDITH T.TERRY =®� $ 1�` TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL S CATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No . 910-R Residential X Non-Residential
Fee $ 10 . 00 Septic Cesspool X
New Existing X
Name Of Owner BOLOBANIC, NICHOLAS
Mailing Address 1 BOLOBANIC, CATHERINE
Mailing Address 2 P . 0 . BOX 603
City St Zip MATTITUCK NY 11952-0000
Property Address 1 182 CAPTAIN KIDD DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8681
Tax Map No. section 106. 00 block 5 lot 14. 000
Cross Street ZENA ROAD
Date Of Last Pump Out 0/00/00
Issue Date : 11 /09/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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' OFFICE OF THE TOWN CLERK \��FFO��
Town of Southold �� C 9/0
Judith T. Terry, Town Clerk �� T Ol/ Application No.
Town Hall, 53095 Main Road - � �� ,��:.
.•C Residential
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P. 0. Box 1179 � cti- '�`�`'"�`'� �i ��
• ., ,,.�� s• �. Non-Residential
Southold, New York 11971 O y �`
Telephone O�
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(516) 765-1801
TOWN OF SOUTHOLD
RECEIVED.
. SOUTHOLD ,WASTEWATER DISPOSAL DISTRICT
ul 02. 1988
Qy�g Clef Southold APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
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DATE Y/ /- ?r
OWNER NAME: 4/444--c
OWNER MAILING ADDRESS: /P'? � re. '(Q8 663'
A ,if if —CI
OWNER PROPERTY ADDRESS: /rA /" b ) l -
/�
//94"c__-.
ciNNER
/9 f<—
OWNER TELEPHONE NUMBER: �� 7f cif/
S /off - /4
TAX MAP NO. : Section �`b l ock Lot ���
CROSS STREET: 7 4474
TYPE OF SYSTEM: Septic Tank Y New Existing p
Cesspool eV New Existing
Residential /, Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
7 ,;IWep-i / -
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: _
1
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N /..r/.5..1rr/alt, „,,IUNLAUTHOFIZED ALTERATION OR ADDITION
TO THIS SURVEY IS A VIOLATION OF
51CTIOI< 77.09 OF THE NEW YOLK STATE
17 G - __323' ECU,.ATIOI. LAW
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eV' ,SSQ 1Y) T�TIO:; GUARANTEE; ARE NOT TRANSFERABLE 'IAN/9,/949 ASF/LEND./672 t{
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etTG ADD;IIONAL INSTITUTIONS OR SUBSEQUENT
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Lot /82 InYOUNG &
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`� 0). REVISIONS
,\ 400 OSTRANDER AVENUE, RIW_RHEAD, NEW YORK
N i! ALDEN W YOUNG HOWARD W. YOUNG
\` 8�j°0030��Y - - w N PROFESSIONAL ENGINEER AND LAND SURVEYOR
/' '��, LAND SURVEYOR. N.Y.S LIG. NO, 1245
BQ,�^^��tJo�/y E3
N.Y S LIC. NO 45893
FOR:
now or foNICHOLAS C. BOLOBANIC & CATHERINE BOLOBANIC
!�/exo�d�o E'p/dy LOT NO. 182
11CAFTAIN KIDD ESTATES" '�� _ ?� '�
AT MATTITUCK III G AR4PTTrED TO: '"• y 1
sQ'u3 HOLD sAVlr.�rS aAN„
TOWN OF Cr R; NTCsEb TITLE-OJYI3k J' 1F
SOUTHOLD A`,En;CA!4TITLE:N300RAN C• $CO
SUFFOLK CO., N.Y. Lam, J, ti ,'. ,
SCnLE• 11
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DATE. APR 0r�.,; • ,IJ
t‘77-77"87-, = 30, APR.3, I9 I o 7 3 --`_- -7�3' 0