HomeMy WebLinkAboutKimogenor Point co (3) JUDITH T. TERRY z Town Hall, 53095 Main Road
TOWN CLERK z, ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
✓ Fax (516) 765-1823
MARRIAGE OFFICER e rr
',�®� �®ifs 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. 3074-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KIMOGENOR POINT CO.
Mailing Address 1 C/O GEORGE R. HARRISON
Mailing Address 2 P. O. BOX 137
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 KIMOGENOR POINT
Property Address 2 COTTAGE #8
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-734-6562
Tax Map No. section 116.00 block 6 lot 24.001
Cross Street JACKSON STREET
Date Of Last Pump Out 0/00/00
Issue Date: 7/27/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK ,I�FF� y
Town of Southold CS
Application No.3 v
Judith T. Terry, Town Clerk
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c $10.00 - Residential
Town Hall, 53095 Main Road ,
P. O. Box 1179 cr) ""'{_ r{'; ' �`` $25.00 - Non-Residential
Southold, New York 11971 O ®_ `.
Telephone _oj •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE � `/
OWNER NAME: KJ'ma Gi1Jo, PO,JIB" Co
OWNER MAILING ADDRESS: ,Z
0, 8O)C /.3 7, New Sof?fo ✓ k /via
OWNER PROPERTY ADDRESS: c® &,,
6,16 6'EEl/a PO/iv' ! Ak w Li< 4J%//75t
OWNER TELEPHONE NUMBER: (cid 7j L— 6 s--‘
TAX MAP NO. : Section // Block Lot Cy 0
CROSS STREET: AC16'6 /1. _ S/ eer
TYPE OF SYSTEM: Septic Tank /-7.1.1 kg New Existing
Cesspool c ? / New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: (6h7h3' ,7,07//
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.)
S':nature of Applicant
RECEIVED BY: -
Town Clerk's Office
DATE: •
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