HomeMy WebLinkAboutBonkoski gtr
Town Hall, 53095 Main Road
•�' P.O. Box 1 179
- lam O '�!�� Southold, New York 11971
JUDITH T.TERRY - � " �1:�°�' TELEPHONE
TOWN CLERK
! .r �/�� (516) 765-1801
REGISTRAR Oh VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 933-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BON KOSK I, MARY
Mailing Address 1 BOX 74
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 ALVAHS LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6400
Tax Map No. section 101 .00 block 2 lot 24.001
Cross Street COUNTY ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 11/29/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
' 4, iii i.�
OFFICE OF THE TOWN CLERK �FFU
Town of Southold �� �'C A lication No. X733
O� OG�_, pp
Judith T. Terry, Town Clerk .� i . ' t`::::: '''i .
Town Hall, 53095 Main Road g 4- :::, . 1 Residential
P. O. Box 1179 t :.;34;---',•:",` ! �,' Non-Residential
Southold, New York 11971 O O AO�iJ
Telephone = 1 * Y► P '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for .,
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
. DATE ///c9--'2/FT
OWNER NAME: 4_ . i '
OWNER MAILING ADDRESS. bp - / e71,-A4 - 0-14
atitj :14:-
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: °1, ----t`p f d
—1)
y TAX MAP NO. : Section /6 1 Block Lot 2 LI,
CROSS STREET: C_ _ fi 14 7
TYPE OF SYSTEM: Septic Tank , New Existing
Cesspool New Existing
Residential Non Residential
DATE OF PREVIOUS PUMP-OUT,: 6 / ----7-----6-4 -2.,,_:,-t";,,---4 -2.,u9-cl
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.)
9917
gnature of ' pplicant •
RECEIVED BY: , (,t),c41
own Clerk's Office
DATE: Vol 7 7 7
/b/ _ 2 - aq. a �.
1 2 4 . 1
<17/mss/