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HomeMy WebLinkAboutKrudop, Robert (2) o � ELIZABETH A.NEVILLE �0'~ .# I Town Hall, 53095 Main Road TOWN CLERK 2 Z P.O.Box 1179 REGISTRAR OF VITAL STATISTICS �.O � Southold, New York 11971 MARRIAGE OFFICER "-..WA a0lei Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER _ 1 * �► ,oi' Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER - •....,.•'' southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 j or Non-Residential @$25 Application No. `? Z Permit No. Owner Name Owner Mailing Address ZcO Oie_SJa L . ►M 41.1-k 1 /i4cz Owner Property Address IfC(Tv < - 5 L- L-- i i f 4 - �X it'isz Owner Telephone No. 251.6-'74-- Tax 1$-'7STax Map No: Section 1'27.- Block Lot �L(' Cross Street S _ / Please check each that applies: New Construction Alteration to Ex7ig System Residential Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy survey t ► 111 approval.) Cfr5". Sign. e of Applicant D e Received by: I. NO / .t; / smillr•Z . /// .i..-/ / / / 7;;'41.. i tal'i / 4fi/ .9'L .4.....t.f....iise. . 9Z% . i :t t illit3041,0 I Pie? .7 3PE4 f 3sn c., -/ 4410 OH t.6 I, z... 4'4 ff. 6 e e p •-**.--. •rtt cry IN 1 / 114.11.114111111hihi..‘ Setais 000,* 17,4-• CI) ) 4‹ ,...* I 1 41. • 0 1.4 tk / . / Cr) .,(.1 . 1 ti < 111 I e 0 .4) II 14 i ;4 if) ni / I az, . I N:,.. co sti %11 9S'LLZ M .0 1,SS.Z0 S • - t-- N 1 N 1 .. 3cIld '3'" 3V-L ,OrGL • . - 1 I 1,92. 0 N aNno4 ., . ..._ . _ . ..._ ..._ _ _ hire Ifl •liatiloW .4 203 -Tim 3-6d . . - - .. d. - ." ... • . •• ; • • . • I • • t • P 1 • • ' .. • t 4 • I. . • II 1. 1 I (MKS NI WILWA onena) - • g 1 . r4-1\--,VrI alil.f H'I0 • • 14 i , SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES it APPROVAL OF 00!•: -:"i7JC;7:7F.D WORKS FOR ?I deq-,,,,, A SiKf.:',:•LE F-.1-,',=;;i2!'" --:":::::;I:rIN:::•Z-.^ . 0 ---- ' Date APR L9_2005 11,C. F:;,-. ",;* :,.iSi 0'04-0).3) 0. ."-•Lam % " xi t... r- eeti - i • ' ---..-..-i o,,:l ye1%r r,! -C::: ,.::- ;;,;-,-:: :.''.th'• s '.ocifZ.-...11 hays brJen I1 %dd.':ii:i.Z...jia::::. • -- -„ .•.;. ;'. -' ,:-...,j;,..,-th--:::;,:..;--.1,',:,:,2,.,-, p.r..'.::,':' ....,•.--,,,,ri-..:fi.7,•,,wr.'i fwnd to - 1 li- - 1 ' ! s.” ..zrr.,..-:-.:-..: 7.:: ' , ''., ) ..::' .,','..:(:-.Th..?;;;' :1. ,, , -,..,,, A , .,:i' 7 n j ,',li,J `j. ', -iS j .....,_ _ . 4",,c:12/11frN _— Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 04/26/05 Receipt#: 2641 Transaction(s): Reference Subtotal 1 1 Septic Permit-Operation - Resid. 4282 $10.00 Check#: 2641 Total Paid: $10.00 Name: Krudop, Kelly& Robert 4650 Ole Jule Ln Mattituck, NY 11952 Clerk ID: LINDAC Internal ID:4282