HomeMy WebLinkAboutKonkel JUDITH T. TERRYcr, Town Hall, 53095 Main Road
TOWN CLERK �� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 4 Southold, New York 11971
MARRIAGE OFFICER 'k�® Fax Fax (516) 765-1823
��� ��® ! 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. 1845-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KONKEL, WILLIAM
Mailing Address 1 7405 MAIN ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 7405 MAIN ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4836
Tax Map No. section 122.00 block 6 lot 32.000
Cross Street BRAY AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 2/12/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK, •c,3uFF�(,(� •
Town of Southold � CQ Application No. /14zS
Judith T. Terry, Town Clerk �` t"
Town Hall, 53095 Main Road _' �G ) $10.00 - Residential
P. O. Box 1179 $25.00 - Non-Residential
Southold, New York 11971 O 4 {' *-$
Telephone - Q/ •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT '
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ d Q, 6O -
DATE
OWNER NAME: (Alf it t d M o N' k P.L ( el?'F !Lc)
OWNER MAILING ADDRESS: 7'05'
( cg-
• - OIAER _PROPERTY ADDRESS: - - "
OWNER TELEPHONE NUMBER: fr t{ �,5
TAX MAP NO. : - Section J' t Block Lot
CROSS STREET: - 0 V- - R .Fe
TYPE OF SYSTEM: _ -Septic_Tank -- __New - Existing
Cesspool X New Existin
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: J? J _ / cj'c7f
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.)
‘f(e4‘?. -2, ) 01'14°--e
Signature of Applicant
RECEIVED BY:
Town Clerk's Office -
DATE:
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