HomeMy WebLinkAboutKehrbaum JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK ® rrri P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Erb �` Southold, New York 11971
MARRIAGE OFFICER ®
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Fax (516) 765-1823 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. 2036-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KEHRBAUM, ETHEL
Mailing Address 1 2480 CAMP MINEOLA ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2480 CAMP MINEOLA ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8028
Tax Map No. section 123.00 block 5 lot 1 .000
Cross Street KRAUSE ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 2/22/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �FFO
Town of Southold 4 ++ 4 . Application No.aqD
Judith T. Terry, Town Clerks AN, y
Town Hall, 53095 Main Road _ ;ti;: - $10.00 - Residential
4
P. O. Box 1179 �' Or{'' $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. 2_ 03-6
Fee $ 1 p , o b
DATE•
OWNER NAME: (°G/ l i'
OWNER MAILING ADDRESS: o2(L"JC )� iYvi�
2 92 a7z ���
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 9P^ P �� a
TAX MAP NO. : Section 1 cz3 Block —5 Lot I
- CROSS STREET: /[J
TYPE-OF_SYSTEM: .Septic Tarik New Existing ,
Cesspool ,✓/ New Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: '4' a J 9 9 2--
LOCATION
,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.)
C° L/X- / •
Signature of Applicant
RECEIVED
RECEIVED/ 'O5 I9•=:44 1, Pte: -
T.wn Cler 'i fice V .
Southold Town Clerk
DATE: