HomeMy WebLinkAboutKardwell 04°C:34°
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r Town Hall, 53095 Main Road
v P.O. Box 1179
�® !� Southold, New York 11971
�;i�••• FAX(516)765-1823
JUDITH T.TERRY � �i TELEPHONE(516)765-1801
TOWN CLERK
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. 1235-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KARDWELL, NANCY J.
Mailing Address 1 P. O. BOX 775
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 1100 BACK LANE (AKA MUNN LANE)
Property Address 2
City St Zip ORIENT 00000-0000
Owner Telephone No. 516-323-2483
Tax Map No. section 17.00 block 2 lot 15.004
Cross Street MUNN LANE AND THE CIRCLE
Date Of Last Pump Out 0/00/85
Issue Date: 8/25/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• .9
OFFICE OR THE TOWN CLERK 'c�VFFO(,lr - _
Town of Southold C'
� O = Application No. % ,b�
Judith T. Terry, Town Clerk % ti ',4 ✓
Town Hall, 53095 Main Road -< 1 $10.00 - Residential
P. O. Box 1179 cryr ' '
�10,t � .�;,� '� $25.00 - Non-Residential
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Southold, New York 11971 `®
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Telephone /Q( xst `\-6�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT •
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /U '9' r^es/de2_• ,
DATE 'IF'��` i r -
OWNER NAME: CZ) < •
•
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OWNER MAILING ADDRESS:
/ z-c n k �a_41,e, , 77;_
/5r,rer` ��� /, //Ys
o//Ce__ nc�� � s =K.6) o 13Q�41.210
OWNER PROPERTY ADDRESS: C
/0766)1)2- 7- � . /7, a -/$
r:e
OWNER TELEPHONE NUMBER: �� 3a 3 - /J23
TAX MAP NO. : Section /7 Block o2 Lot 1s,
CROSS STREET: /9-7ur n 2_ e_ e (D ve (ldlet% z )
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /77
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.)
gn- e o Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
r y
ROGER TABOR
L44. BOX 275
ORCHARD STREET
• Let 1. ORIENT, N. Y., 11967
516-333-2604
EXCAVATION ■ TRUCK CRANE ■ DUMP TRUCK SERVICE
H.D. Ref. No. /041
Name of Applicant $-S, P/Y Phone 32332983
R42,80/ 77.1r (ower er+— _ ter)
Address
/71Gri�'/►/ A'4/C('� 12- /f',d)l?RJ.F/l/T N/J //9-s
Property location (include distance to nearest -
cross street) Al/ •
/ Hamlet74'/�-iY7 Township 3 'UZy'LP
Subdivision j/9 Lot No. /77(/49'
Type system installed:
Se tic tank '
(a Volume
(b Type
Leaching pools:
(a) Number and size ,/,69-
(b)
ize /,fn(b) Type 5-4.09---"Aar , Eas-s
I hereby certify that the private subsurface
sewage disposal system described above has been ,
installed according to current criteria of the ;
Suffolk County Dept. of Health.
Date /+�G( /97/ Signature r``' G;��
Title .Tic'72¢L2 /P
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