Loading...
HomeMy WebLinkAboutKahn Ar( ®s �e-N1I1 00, � t� 7 Town Hall, 53095 Main Road 14 ; P.O. Box 1179 �® Southold, New York 11971 JUDITH T.TERRY ,� �, � TELEPHONE TOWN CLERK (516) 765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 5373-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner KAHN, HILLER AND WIFE Mailing Address 1 255 THREE WATERS LANE Mailing Address 2 City St Zip ORIENT NY 11957-0000 Property Address 1 255 THREE WATERS LANE Property Address 2 City St Zip ORIENT NY 11957-0000 Owner Telephone No. 516-323-2691 Tax Map No. section 15.00 block 7 lot 13.000 Cross Street UHL LANE Issue Date: 1/16/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) J ,� `OFFICE O THE TOWN CLERK cvFFQ(,(" T. wn of Southold �� CQG=� Application Judith . Terry, Town Clerk Town Hail, 53095 Main Road $10.00 - Residential 0. Box 1179 $25.00 - Non-Residential P. %,. Southold, New York 11971 4 5 *-$ Telephone Telephonef.( , t • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ 1�,, y, DATE -) SW /® /997 OWNER NAME: /1/ /lEA / // iI'J �` l' F OWNER MAILING ADDRESS: Z, ,5� I CT4 z 2 10, 57c72/2 �JV 1 / *- OWNER -OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER:C 7_4 ) 3 ,g 3 4 9/ l /3 TAX MAP NO. : Section Block Lot CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential �/ Non-Residential 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.) • X ` ri.-- Signature of' Applicant RECEIVED BY: , Town Clerk's Office- DATE: / / / _ - ' _ a s �y ' '. - .a • tf^ v.-k1 - , , 1 .'1. . 4 ' Y• 1 Yi!i'• - •.:,t`: ,' ,r.',r, 1 - r61- / ¢,' .rW � nf l 'S 1 V !'4it''r ; .i t �. • ��• w` •"a •. e '•"••Jb .` ,r..... i' ',�- r '4 9f , ;r w•!...; _ 7.V ` ., • _ Y{ira r :+ � .-'' • :::.F" tf'. *''' ;1 S { '- a r rof -YM Sr.'•1 �•.r.•Y, ��.• r r:• 1. 7. ,,v't • a •.rt. -Sr' , • • + '•fi•,F .kip C ,, '• ,t'N,,. - -Ii rV.2 t•':Y ,A !' . " o4 �' '; -`S Orr t :! • r •; IPM.4. • r_ S—.._ ... , 4 h i Q�� _� qi V =b •- 4.• •. ‘A A ) Of,•• ,4, •••, • ,f, ' 7-o ,',.• -. -\..1.,k • - -, .. , 7'r..ii ',. ,V `6,,��:•,yy�irl,;c"il/�"-_I _ ';,F A,• - 14 - .J' . . , -,_ 4,,:.5Cedke 401.451 /11 .1 ' . i''' 'r • rt 'K. ,� ' fterft fT f/ f ••t,• . ! I` - $ .4; p . .f ` _ a7�, _ -+( _. b, ,} >.• .• ' . .4f ,i .0..O•/•./ " µ I. /...93-1/. /:, -,- , '^I I• - .. ,•.-7 / F/ E1."`"se!♦ C//F/rtr ht.— '.0 "�, ec 3 -' . E � •. ." M'4-.10`t,I �P ;yt+ _A c✓ Jw �///WW1 »:/' ` ';C cA'•5t- coir-Ge, 1119 1l ,Z,J A -