HomeMy WebLinkAboutKoukounas fil4iL�1�?%i/T��i . �y�?i
JUDITH T. TERRY Town Hall, 53095 Main Road
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TOWN CLERK t1 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER ,V ,•4' Fax (516) 765-1823
�j�® ��® 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. 1842-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner KOUKOUNAS, KONSTANTINOS
Mailing Address 1 24-13 35TH STREET
Mailing Address 2
City St Zip ASTORIA NY 11103-0000
Property Address 1 RICHMOND ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 718-721-0091
Tax Map No. section 51 .00 block 6 lot 15.000
Cross Street ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 2/12/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
o
OFFICE OF THE TOWN CLERK
FFO y�.
Town of Southold %c3\\_ . t Application No. �P
Judith T. Terry, Town Clerk =' ,
Town Hall, 53095 Main Road $10.00 - Residential DC
P. O. Box 1179 to ', ' ► $25.00 - Non-Residential
Southold, New York 11971
TelephoneO.( va� of
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT _
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /O.O'0
DATE .Z Za -
OWNER NAME: l<c)vl<outiJ o,'Si,1 /,o.S
OWNER MAILING ADDRESS: 2 - /3 35
• ,4'Si o/Z1I / Mf /I/o 3
1\k) OWNER PROPERTY ADDRESS: Cv ,Ato
OWNER TELEPHONE NUMBER: 7/8 - 721 - Da ? J
TAX MAP NO. : Section 5'/ Block C, Lot B S'
CROSS STREET:
TYPE-OF, SYSTEM: Septic Tank DC, New De—__ Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: •
LOCATION MAP: Must be attached hereto before permit maybe issued.
(Locate building and system; give north arrow and feet
_ of distance, -approximately, to building and closest- road.)
- 4
ignature of Applicant
RECEIVED BY:- bi°'
Tow Clerk's Office -
RECEIVED - -
DATE:
Town Clerk Southold
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COARSE
Fa?D Srlj T.N..#1 ', Jan 23, 1991(re vise)B O.M s•
.4-\-HIST s a. �- <' _ 0 Jail. 214 1992(foundation)
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TICOR TITLE GUARANTEE COMPANY
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/ �,,� LIC. NO. 49618
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Prepared In accordance with the minimum E
standards for title surveys as eslablishedd' �a�„'`�4
by the L.LA.L.S. and approved and adopted IL.t.5PEO �/(( �$ I ' �$, /?(P,
for such use by The New York Stole Land -
�� Of4IV (618
Tl/le Assoclotloa. O : AREA = 42,446sq.ft. A O�'' :_9, '
- \f‘i
MAIN ROAD
l3EVATtONCR ARE TO ASSIMO DAM( ¢/sc .o.✓ 2 - - - - SOUTHOLD,'NY. 11971
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