HomeMy WebLinkAboutLonk, Rudolf ,•%OF SOu4,
ELIZABETH A. NEVILLE • A� lQ Town Hall, 53095 Main Road
TOWN CLERK * *; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ,Itc`
New York 11971
MARRIAGE OFFICER �QQ�1�' Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER L0re ��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER comm,\\c*‘‘
1 0 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4292-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner LONK, RUDOLF AND JACQUELINE
Mailing Address 1 25 MOOSE TRAIL
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1
Property Address 2
City St Zip 00000-0000
Owner Telephone No. 631-734-2050
Tax Map No. section 103.00 block 4 lot 3.000
Cross Street BEEBE DRIVE
Issue Date: 9/20/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
i 1
' 1FOL4'
49 \
/0 4
ELIZABETH A.NEVILLE -1 Town Hall, 53095 Main Road
TOWN CLERK op z ; P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ‘1041_- ! �/ Southold, New York 11971 Fax(631) 765-6145
�
MARRIAGE OFFICER , 0 �Q
RECORDS MANAGEMENT OFFICER = 4 * *g,d� Fax
(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 Vor Non-Residential @$25 Application No. LY 40 "
Permit No.
('
Owner Name R II`t- 't- J ae.G .(L _.1 A. ��
Owner Mailing Address 2-5 MOcse-TF-,
CL-1-c-h(D6uel kl'i flq5
Owner Property Address 466t1V..Q,
Owner Telephone No. b, I--- 4-14- Zo50
Tax Map No: Section IbTb Block 4 Lot 3
Cross Street 1(. +� br,
Please-check each that applies: New Construction
Alteration to Existing System
Residential b< 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 of survey with SCHD approval.)
Q - qq as—
Si t(-' 'ur of Applicant Date
Received by:
l2O, S/
. to. • - b
. '
04,
(,......A6 -i..:•• t-:--t----1) 1.4.---' .
•
. .
_ ___-.......
T1.; I
1
(
1 l• „: i -
,-, ' I 'Cr-- •
1 :
; t
‘t,
1 .
. .
r ,
. .
. ..
• '1\4
. i
k.' \ .. ......._ . - (kt.1144•04/1.'4. .
'...‘...., 4,
di 1.4,41.4041"1
4
A....
,
).-k, 11' cl
41,
... ,.____.,- A ......e ..... I
\
. . .
...,1I'
4"---
*
4 .
1.) I /40••1....1.,_ALt".•,' 4-1--- ,
l 97 ' . .
i .
:..
1
S .
i .
/411'7 l'i
/ tieti•
1 ., . ..
t/
44., ....- .
A i
ihi 411.
it
c I
' ‘....e.....:(41;4:1 .
. t Mk _.----. ......._....
ig,i......,
11
iiicl' .