HomeMy WebLinkAboutKaswell ; ®
,. Town Hall, 53095 Main Road
i oll s: �' P.O. Box 1179
est
®� 1� Southold, New York 11971
JUDITH T.TERRY A`I' FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1507-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KASWELL, WILLIAM
Mailing Address 1 P. O. BOX 397
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 2041 CARROLL AVENEUE
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-765-5424
Tax Map No. section 74.00 block 3 lot 4.001
Cross Street ROUTE 48
Date Of Last Pump Out 0/00/00
issue Date: 7/26/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
S irI.
OFFICI' OF THE TOWN CLERK ���FFO
Town of Southold ��S �C� Application No. '
Judith T. Terry, Town Clerk % '�}.. .i�
Town Hall, 53095 Main Road .- ' .�{ e4 ' $10.00 - Residential -�.
P. O. Box 1179 LI-3 { `` i •
� ,,�. # ��,.�;A,� �, �• $25.00 - Non-Residential
Southold, New York 11971 O ® -?° 0� '��`
Telephone - -1 , �� '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - - - for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. +
Fee $ lQ .cO
DATE r1'03/70
OWNER NAME: llv r 1(1ail( V, 44.$WELD- •
OWNER MAILING ADDRESS: 317
, Cif3-34,1)2 ofli‘( 1t1S16
OWNER PROPERTY -ADDRESS: (1-Q-2.
Te 1At
,
OWNER TELEPHONE NUMBER: X' S4ZL,
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TAX MAP NO. : Section Block3 Lot :4,1(1
CROSS STREET: 'f 4S ,
1
i
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
i
/ i
Residential r� Non-Residential 1
" . DATE OF PREVIOUS PUMP-OUT: ilAk<tb“)
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.)
(Z( Fa u.-141a)se
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30 hZk2 411 --/:---- 111 ----
igna e - ' pplicant
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RECEIVED BY: _�� , -
Urod Clerk's Office
DATE: JUL 2 6 le"''