HomeMy WebLinkAboutKinnin OFFICEEOF THE TOWN CLERK
'-;own of Southold �
Judith T. Terry, Town Clerk %
Town Hall, 53095 Main Road `
.- '
P. 0. Box 1179 cn '`"
Southold, New York 11971 �i ,. • _-- `c-o
Telephone _0(" s 1%
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 390 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Lauren E. Kinnin
OWNER MAILING ADDRESS: P.O. Box 78
New Suffolk, New York 11956
OWNER PROPERTY ADDRESS: Corner of Third and Orchard Street
New Suffolk, New York 11956
OWNER TELEPHONE NUMBER: 516-734-6881
TAX MAP NO. : Section 117 Block 7 Lot 12
CROSS STREET: Corner of Third and Orchard Street
TYPE OF SYSTEM: Septic Tank New Existing
•
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: March 3, 1985
a
Judith T. Ter �r
Southold Town erk
DATE: August 10, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cs\FFO1,r.
Town of Southold
' CQ ' Application No. 3 O
Judith T. Terry, Town Clerk , . ' : °`
Town Hall, 53095 Main Road
> Residential
P. O. Box 1179 u' `�: , 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. 3 �O
Fee $ /0
DATE At !o. /o, ,y,97,
OWNER NAME: )iec. 66c°6":A" y /,a
OWNER MAILING ADDRESS: 0 . 0x 7,r-
/1744-4/
T, 1/Eh/ S c,caL,- /VV //9J 6'
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OWNER PROPERTY ADDRESS: %ao . '7x 11 C s')
6?,r . cee ' ���� r/9-`Z
OWNER TELEPHONE NUMBER: Com/ 6 ) 7iV-- 7f/
TAX MAP NO. : Section 1/ 7 Block 7 Lot / '—
CROSS STREET: Vel.) £47l (?2c-ILev.y,t, �.,vn/y,oz,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
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Signature of Applicant
RECEIVED BY:fT t ,� C�-( �w
own erk's Off ce
DATE: P-- /0-
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