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ELIZABETH A.NEVILLE ® Town Hall, 53095 Main Road
TOWN CLERK 2 P.O. Box 1179
11.0 PPP 1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �`; ®�,�� Fax(516) 765-1823
'MARRIAGE OFFICER. IO./ ��d�aNg
Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3815-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner KASSNER, ROBERT & RUTH
Mailing Address 1 145 TEEPEE TRAIL
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 145 TEEPEE TRAIL
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2822
Tax Map No. section 87.00 block 2 lot 32.000
Cross Street
Issue Date: 9/16/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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' OFEid OF THE TOWN CLERK
'TOWN OFSOUTHOLD ,1 V . �• �: Application No.
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ELIZABETH A.NEVI'.I.F,„TOWN CLERK G $10.00 --Residential L ®"`�
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 �� $25.00 - Non-Residential
--<; -- Telephone • _O Jig #.09.
(516) 765-1801 -- 'i
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3 'F c”
Fee $/e)••.00C)
DATE fL PT / ', /6(9g
OWNER NAME:--Wpi.. egr 6-�. -1'-' ./i /Z ,55x1 ? 2J
OWNER MAILING ADDRESS: /44,5Gp. Z7 i RILL
S-o v r O t3 ,. -4t) Yek/' /197/
OWNER PROPERTY ADDRESS: /4S Orr-pct 7i2.14 c_
SDomoi--1\ 1 /li YO ( 1 )97/
OWNER TELEPHONE NUMBER: (%G 7‘6"-- . P�,),,
j TAX MAP NO. : Section 017 Block 920 02, Lot 03 - -- ( q)
CROSS STREET:
TYPE OF SYSTEM: Septic Tank V New Existing ' V
Cesspool / New Existing
Residential 1' Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued. _
(Locate building and system; give north arrow andj feet
of distance, approximately, to building and closest road.)
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RECEIVED BY: /_
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Town C k's Office
DATE: 9,/ S
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