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HomeMy WebLinkAboutKanev .00N 4 JUDITH T. TERRY ::, Town Hall, 53095 Main Road TOWN CLERK ® it� P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER ® Oof Fax (516) 765-1823 ._494, ®� ®csil 0.. Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1903-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner KANEV, LLOYD AND KAYE Mailing Address 1 155 EST 38TH ST. PENT. D Mailing Address 2 City St Zip NEW YORK NY 10016-0000 Property Address 1 FIRE ROAD #3 Property Address 2 ROCKY POINT ROAD City St Zip EAST MARION NY 11939-0000 Owner Telephone No. 516-477-8915 Tax Map No. section 21 .00 block 1 lot 27.001 Cross Street ROUTE 25 Date Of Last Pump Out 0/00/00 Issue Date: 5/15/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) I OFI`ICE OF THE TOWN CLERK sc0FOU.�'� Town of Southold ��� CQ --• Application No. Judith T. Terry, Town Clerk �� •� ,b $10.00 - Residential Town Hall, 53095 Main Road •^'' off.,^ .� � . u' p. O. Box 1179 , • jr " • $25.00 - Non-Residential - �, , . Southold, New York 11971 Telephone _ • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. /965 Fee $ DATE Maki 15) 19902 OWNER NAME: I..I dol 44. Ka - '<o wwu OWNER MAILING ADDRESS: 155 E40-- /Pent ' X " NY NY boli OWNER PROPERTY ADDRESS: R,©aa--*s ) IZC9Gk P01►&t -goad. yrt' maxi-0-1A , NY 119.5 OWNER TELEPHONE NUMBER: 1} ('� - 1 t5 Q[. (2 i) 6 - 59% TAX MAP NO. : Section 0 21 Block 01 Lot 2'7 , I CROSS STREET: IAu TYPE OF _SYSTEM: Septic Tank 900 ,1 _ _New ✓ Existing Cesspool o New Existing ✓ Residential ✓ Non-Residential DATE OF PREVIOUS PUMP-OUT: 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 ofAppl ca t RECEIVED BY: /- / Town Clerk's Office DATE: 317/3 /1�< A ti • +� ;� r i•-y— V Vim '✓ -- - � �--� - - ---+---- --• - +-- -- ------ --- ' - -'-- - a 1 F• 0g _ 1-, m o - - i.,o - I II • cp r4: -_ - _ --- -- - -- - !4tg x ' --'Z1"o �pcn� --- • - - -- - ---- -- - w._;-_•_- . co a Rau sem-) i- 1_ ma y' rIt �a ------ - -- — — -- --4 =� %Dxhit5=on__ m o co / mi yr1Ft 2 k> Nl � m -- ---- •— — • rO O m • , c - *CCUT'5 CO'Srr"+/. _______ _____/ ____/___T_ ___Nt__ -11.._ 1_ 1"-___8_!_4.6L -, - 1- - ,- 1 ---'--. 1 _—__ :CQ_ y IILTAJ- 13.‘. 1 6 - ---- - ---_ T215:02przu UM- _�_ `iPTIC. T�T�K sr: ''r------7\4 ?V P=j] atJr D ..--' •---`---•------- ----------- - - - --- m m Ft _ - -----•----- - . ---- -- _ _ Calk -