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HomeMy WebLinkAboutKoehler „,i \OSVFFO(,tCoa- JUDITH T.TERRY �� y� Town Hall, 53095 Main Road TOWN CLERK %% P.O. Box 1179 t Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O \4f* ®��1�' Fax(516) 765-1823 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER <( �► ,�i� 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. 3401-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner KOEHLER, A & E Mailing Address 1 71 CAROLYN BLVD. Mailing Address 2 City St Zip FARMINGDALE NY 11735-0000 Property Address 1 1595 BAY SHORE ROAD Property Address 2 City St Zip GREENPORT NY 11944-0000 Owner Telephone No. 516-420-8872 Tax Map No. section 53.00 block 4 lot 5.000 Cross Street KERWIN BLVD. Issue Date: 10/30/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) • FFIGE OF THE TOWN CLERKc��1F�(/r ' Town of Southold O&V CQG'_, Application No2 Judith T. Terry, Town Clerk Town Hall, 53095 Main Road a $10-.00 - Residential P. O. Box 1179 u' '' i ;' $25.00 - Non-Residential Southold, New York 11971 4 ' 0 �/`, Telephone �j * .ge," (516) 765-1801 TOWN OF SOUTHOLD , SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • • DATE ! Q•aq J OWNER NAME: 4 k OWNER MAILING ADDRESS: I t CG 1 6kVa 1"='l• 1 1r73 OWNER PROPERTY ADDRESS: � • OWNER TELEPHONE NUMBER: ( U) g- TAX MAP NO. : Section -S-3 Block Lot CROSS STREET: K fjeyo i NR- b TYPE .OF SYSTEM: Septic• Tank_. :' : • New Existing Cesspool New Existing R 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.) Signature of Applic t RECEIVED. BY:, Town Clerk's Office • DATE: r: lei. 4"5e 4'7 a O' G• .. ti 92..0 . Y" Hg ede ; ; I f :L' 13Li\ L '� , - 1 5 {A + ►. a � tom„.:i2,1,,,,- S �./ �Y}y i*1 L.--. re- j i }Yi , _ �4 - ' '- .Y ..f eV 1 Q_-_ it4 = ;: 0 .. 30� + Ga�/o O3� i 1 44 U Q s, .r ti . rte_ -,.` ii :,: � �` %Ys s f oy, .c i 1' a r/ FY•Z wig t,ot�sC, 1 i ©� i :11-°" 1 - i awe 4*-3 .ea eve( p • s . . - - � LU 5. 4 S 4T a0`w i Z ._ a3a c_ - .; 4 ' - '-: ccs • 3O 1 ' - MAp`o- LAN 0 -: ,. . SLi(ZV�:YED FOR. K - -- C! - 6�t-a Q%- �;lh-t a 1-ii- .- ., . _F A . `ON ST 0 p - - 02 - 1Y0!-4 pi c.c. Nv-t'` = `G�'- !',U t-t- t)e Y s i✓c�\6/ Y e'r. 1" 4:0 - • -iA►- t� =1 t'.r c: t off- ' f:..:..: TOWN. OF SJ' QUTi-401.....0 _N :Y1 ' r .�+ -4 �;, „ 1 - `` %`-„ r 6 i--