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Home My WebLink AboutHoman (2) JUDITH T. TERRY ; Town Hall, 53095 Main Road TOWN CLERK ® P.O. Box 1179 REGISTRAR OF VITAL STATISTICS ih � Southold, New York 11971 MARRIAGE OFFICER ' Fax (516) 765-1823 �� ' Fax (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1652-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner HOMAN, KENNETH Mailing Address 1 P. O. BOX 914 Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 1180 GRATHWOHL ROAD Property Address 2 City St Zip NEW SUFFOLK NY 11956-0000 Owner Telephone No. 516-734-6078 Tax Map No. section 117.00 block 4 lot 8.000 Cross Street FANNING ROAD Date Of Last Pump Out 0/00/00 Issue Date: 4/08/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) (I`=FICE OF THE TOWN CLERK .c,\\FFULA' '- Town of Southold � CQ % Application No. /65 Judith T. Terry, Town Clerk o tom. y Town Hall, 53095 Main Road $10.00 - Residential K P. 0. Box 1179 � � $25.00 - Non-Residential Southold, New York 11971 4 O .:..... . 410 Telephone j Y► ' • (516) 765-1801 ,, TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT • APPLICATION fore OPERATION PERMIT + ti' SEPTIC, TANK or CESSPOOL Operation Permit No. Fee $ 10'0 DATE ,3II2-/91 OWNER NAME: 1- 143 4-61/4_,LA-N) OWNER MAILING ADDRESS: 90 Wil(, 004 Gina—voo� kw [l4 3s' OWNER'PROPERTY' ADDRESS: (j�fl�t'�=� P Qsoccoult, L it 9570 OWNER TELEPHONE NUMBER: 7,54— (067,V ,...t —//7— �� ' TAX MAP. NO. : Section 4 s '= -' Block Lot CROSS STREET: cA 1.S11, Cb R-b. TYPEOP 'SYSTEM: Septic Tank , New Existing Cesspool New re Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: . /MI 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.) Signature of plicant RECEIVED BY: Town Clerk's Office DATE: _- . N^ r.4) t:fz :.' • it . y 1 J ' '1 .)rt fin-. X. - I-14,Y V_..._.._—1% /t_ L:t.i, `J'-,,.1 `- r3' • ,. 4 , W f -jT7-)-16 (t Oc.© fP t F . !` ";117-2-e `r!, �5 • mw.cert..Orfv......d - - - '..,ui77t[dill*MwelWtlx . 4. ''" '1,....4 of ft*lorf..l..q M'#4#4. _ _ � Md .i �yR ,:r.,..: 4 • r L+,K•ele•CPl�tom$Aottn a"rra**6 ‘4•A-,:;i. G`a-w5s,ev1rw=r..x.,ztc.:a^ r, `•-. - Aiocirm _ '' n w',ter:.er■f Tx,t..41:1 naC o Pte. - r inc rr.;.aa of 04 lwYYFrtj ktilF ' Fr �yef,,;:�'�ggy T'J[,ss2$e1elRt�f3lfi ........- ... ^fblyYplT - r_ • A.