HomeMy WebLinkAboutBorkowski OFFICE OF THE TOWN CLERK (�
Town of Southold
Judith T. Terry, Town Clerk ��f74-14:,i41; .
Town Hall, 53095 Main Road o ", , Y z
P. O. Box 1179
Southold, New York 11971
Telephone = �. �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLE) WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 556 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: William Borkowski
OWNER MAILING ADDRESS: 660 Pequash Avenue
Cutchoque, New York 11935
OWNER PROPERTY ADDRESS: 660 Pequash Avenue
Cutchoque, New York
OWNER TELEPHONE NUMBER: 516-734-6139
TAX MAP NO. : Section 103 Block 11 Lot 4
CROSS STREET: First Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
•
Judith T. Ty
Southold Town Clerk
DATE: January 4, 1988
(TOWN SEAL)
OFFICE OF THE TOWN CLERK . a
Town of Southold c\-5v4 ~�0.6 , Application No. -57--C:63'
Judith T. Terry, Town Clerk b `�v Residential l/
Town Hall, 53095 Main Road; �: -
P. 0. Box 1179 cn .};. iz Non-Residential
Southold, New York 11971
TelephoneOI 'I .'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ AO '
DATE
OWNER NAME: bOitt.,,,Akt -1-50e&45-4
OWNER MAILING ADDRESS: 4 4c � � % i'
OWNER PROPERTY ADDRESS: c r1 / (uIC
-vT o ///017 1 193-
OWNER TELEPHONE NUMBER: c 6 73 ( ----"‘ .3
TAX MAP NO. : Section /43 Block /7 Lot Ci
CROSS STREET:
- /r i
TYPE OF SYSTEM: Septic Tank 1/ New Existing
Cesspool ,New Existing
Residential C/ Non-Residential
- - DATE OF PREVIOUS PUMP-OUT: I/`' /17
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.)
9/ //61/4"1 .
Sign.ture of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
.4 ,
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