HomeMy WebLinkAboutKart JUDITH T. TERRY �� O y� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r't'e Southold, New York 11971
MARRIAGE OFFICER y ��� Fax (516) 765-1823
®�`® ��®� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1683-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KART, WILLIAM J.
Mailing Address 1 611 BAILEY AVENUE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 611 BAILEY AVENUE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1272
Tax Map No. section 34.00 block 2 lot 7.000
Cross Street ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 5/07/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK .*�FF� 0
`1% Town of Southold �� <_. C� Application No(" 3
Judith T. Terry, Town Clerk t4, 4ti
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 cn 4 $25.00 - Non-Residential
Southold, New York 11971 '55/0'4-
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Telephone j 4 `A
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- — — -----for—OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0, 69°'
DATE -J`7` - 9/
'OWNER NAME: k// ///A 0-kr •
OWNER MAILING ADDRESS: Co I- 80.1 I !iiEJ .
CrWUOrt I\1 ` i eciV Y
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OWNER PROPERTY ADDRESS: -�%
OWNER TELEPHONE NUMBER: ( ( �� - P, oc
TAX MAP NO. : Section 3g1 3 Block 3 = -7 Lot
CROSS STREET: R-E 4q eain
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing t/
Residential JJ Non-Residential
DATE OF PREVIOUS PUMP-OUT: q!J
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.)
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Signage of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
APR 301991
MEI #61 .
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