HomeMy WebLinkAboutKlages OFFICE OF THE TOWN CLERK "c0FOCi(C►-
Town of Southold .® - } ._ �
Judith T. Terry, Town Clerk L
Town Hall, 53095 Main Road c icy .
P. O. Box 1179 ',;cn
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Southold, New York 11971 �_Q •,
Telephone OltIft
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 452 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: ' John R. Klages
OWNER MAILING ADDRESS: 430 Kraus Road
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 430 Kraus Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-4941
TAX MAP NO. : Section 122 Block 4 Lot 37
CROSS STREET: Camp Mineola Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: None
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Southold To Clerk
DATE: October 6, 1987
(TOWN SEAL)
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OFFICE`OF THE TOWN CLERK ,(�
Town of Southold �� „.". . CQG', Application No. 42,6-02-/42,6-02-/Judith T. Terry, Town Clerk ,` ,
Town Hall, 53095 Main Road Residential r
P. O. Box 1179
•' Non-Residential
Southold, New York 11971 O `c-
Telephone
�•`�,
Telephone .(
(516) 765-1801
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OCT®61
TOM Clerk Southold APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0( c")
DATE /6/2--/e17
OWNER NAME: .J M K1i46s
OWNER MAILING ADDRESS: �. 'O /6e.ds ,€
evy,
OWNER PROPERTY ADDRESS : S, /
OWNER TELEPHONE NUMBER: 576 J' 1,6,9 se/
/e-6-0 / `1 3 7
TAX MAP NO. : Section Block Lot
CROSS STREET: G AS m/f1/aGA
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool .>C New Existing �+
Residential >c Non-Residential
- - DATE OF PREVIOUS PUMP-OUT: �i✓�--'
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.)
Signa .re riApplicant
RECEIVED B Y: C' _0L�4 (),-19-(044140-12-4
REC VEDTown C rk's Office
DATE: OCT06 V
Town Clerk Southold
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