HomeMy WebLinkAboutKramkowski kk
VB art' t' Town Hall, 53095 Main Road
�®A. 6_' . F P.O. Box 1179
-4-. 4 1,, 'l�I Southold, New York 11971
`,s2s2 ,
JUDITH T.TERRY V % �'
..zi i "�1I FAX
(516)
765-1823
182
TELEPHONE765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1518-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KRAMKOWSKI, JEAN L.
Mailing Address 1 1450 BOISSEAU AVENUE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1450 BOISSEAU AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-26111
Tax Map No. section 55.00 block 6 lot 22.000
Cross Street MAIER PLACE
Date Of Last Pump Out 0/00/00
Issue Date: 8/10/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ' COFO(,(
Town of Southold �%J'N_ L'� Application No./S'/
Judith T. Terry, Town Clerk % thy'.' k ' 4,7.-_-.-'1 X
Town Hall, 53095 Main Road 0.-- ' r� $10.00 - Residential
P. O. Box 1179 :._ y; O � $25.00 - Non-Residential
Southold, New York 11971 O ® h�'' 0 ��`
Telephone '5501 . ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
DATE 6 199()
OWNER NAME: '3-5AIL) L. k�p,m lcau•
SIC-c
OWNER MAILING ADDRESS: )45D 5D D(s5-ec.,t,
Oc j. I d lL3 Y- / 1971
OWNER PROPERTY ADDRESS: Efr'►'n-e
OWNER TELEPHONE NUMBER: 3/6 ' 76 5— -6 Y7
TAX MAP NO. : Section 5-6- Block Lot 19----
CROSS STREET: -Ina.) ac-g
TYPE OF SYSTEM: Septic Tank " New Existing
Cesspool 1/ New Existing I--------'
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: apprui-z 9 /9
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.)
azt c -aC_
---Y71--61-/d9 6talsgeggiOagle's
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Signature of Applicant
RECEIVED BY:
'• ; I' Vn Clerk's Office
DATE: AUR 1 0 1990
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