HomeMy WebLinkAboutBozsnyak OFFICE OF THE TOWN CLERK �c�FFOU�c"
Town of Southold , ,N,%" 4.
Judith T. Terry, 'Town Clerk - � ,
Town Hall, 53095 Main Road
P. O. Box 1179 `OP
Southold, New York 11971 • _`'O0�- •�
Telephone : 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 319 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Richard E. and Mary Bozsnyak'
OWNER MAILING ADDRESS: 6425 Skunk Lane
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 6425 Skunk Lane
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516=734-5867
TAX MAP NO. :- Section 104 Block 4 Lot 5
CROSS STREET: Haywaters DRive
TYPE OF SYSTEM: Septic-Tank Nev Existing
Cesspool x New Existing X
Residential X Non-Residential
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DATE OF PREVIOUS PUMP-OUT: .. March 12, 1987
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•
Judith T. Teri
Southold Town Clerk
DATE: July 14, 1987 - -
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• (TOWN.,SEAL)
;;,.
OFFICE OF THE TOWN CLERK cOFUG*(�'=
Town of Southold _, Application No. 819
Judith T. Terry, Town Clerk 4
Town Hall, 53095 Main Road `s,
Residential
P. O. Box 1179 )4:4.'}ri��' Non-Residential
Southold, New York 11971 O
Telephone Zvi 0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
/Q Fee $
DATE J L 6) 1 cite?
OWNER NAME: ge,/ i-cl 4 mAky BOzSAJj a
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: tacS, ,iV 1( IAM/
CbtesA
OWNER TELEPHONE NUMBER: 73 V-- S''6 7
TAX MAP NO. : Section 10 Block Z Lot
CROSS STREET: : eoa ?Lei_ _5 Ad. /
TYPE OF SYSTEM: Septic Tank / New Existing
Cesspool L/ New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: /'f, cJ/ lo? , /787
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.)
lat
Signature of App an
RECEIVED By
Town Clef/ 's Office
DATE:
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