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HomeMy WebLinkAboutKoch (2) //',,,`ilii f i®' SUFFo4CO JUDITH T.TERRY �� - �G Town Hall, 53095 Main Road TOWN CLERK 1 y P.O. Box 1179 ft? � Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O MARRIAGE OFFICER =* t-/ Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER . <1 '1►����� Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER �•���,,.• OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3470-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner KOCH, ELIZABETH Mailing Address 1 P. O. BOX 385 Mailing Address 2 City St Zip GREENPORT NY 11944-0000 Property Address 1 700 SNUG HARBOR Property Address 2 City St Zip EAST MARION NY 11939-0000 Owner Telephone No. 516-477-1659 Tax Map No. section 35.00 block 5 lot 36.000 Cross Street MARINE PLACE Issue Date: 5/16/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK � F0(,(�''- yd ''Town of Southold , � •SI rt %. Not 3V No ' / Judith T. Terry, Town Clerk , Town Hall, 53095 Main Road 8 $10.00 - Residential P. O. Box 1179 '{ k ;' $25.00 - Non-Residential Southold, New York 11971 Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. - ' Fee $ /O' ©O DATE ta947 OWNER NAME: C( —a`p.e,--k-in k c�cSn. OWNER MAILING ADDRESS: ICS 13®% ,3 S OWNER PROPERTY ADDRESS: 700 5n c {4-c3 ' O( OWNER TELEPHONE NUMBER: q17 /65-7 TAX MAP NO. : Section _ �J Block Lot &� CROSS STREET: 0-I 1 M,2,' T1 TYPE" OF SYSTEM: `Septic'!Tank �'! New Existing Cesspool New Existing Residential Non-Residential 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.) 41/-4,44 7/12dt 4c ignatore of Applicant C zer RECEIVED BY: " I "' Town Clerk's Office DATE,: , . ' ' . . ' . , . Ir , i''' 1 $ v ' 0 ' •",,.t' ,I,? q! i . l' I '. ' i' , ' IA+'' f : 4 ', 1 / I , , , /1,1;1' e . , /: i1 1 ' ,` : :1' , / 1 1 li, '.'. 1 ' ',.--4 I''' , ' • . . 7,1 / ___ 7 , i ; . . , t , ;1 ' , ' 'i , t ,, „i ; , ' '' ; , I , 4. . / J,. ' ---t .-,' 1 , -i ' , ':','1, .- ' . " ,, 1, ; ,t .. . (, . . : ot CD, C -e-e.-:•A , , ! , . i ,,,----.-7-7-- . ('1 .) 'D,e__ *---'•-C_.) . . . . . , . i N7 ! , 1 , , F , , , , . , . , . u . . . , t1:1 '71. I ct --I