HomeMy WebLinkAboutKrancher oll'ff Rite-
;4' Town Hall, 53095 Main Road
O P.O. Box 1179
0,01 Southold, New York 11971
JUDITH T.TERRY �,�,,,,� ,
T�P°l FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
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. 1013-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KRANCHER, STELLA A.
Mailing Address 1 BOX 222
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 BAY AVENUE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-0441
Tax Map No. section 31 .00 block 8 lot 23.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 2/09/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK 'c0FO(,(�
Town of Southold t4- Application No. /0/3
Judith T. Terry, Town Clerk
Residential
Town Hall, 53095 Main Road aAt„ ,.
P. O. Box 1179 cn : A ' ; Non-Residential
Southold, New York 11971 %O ® r ,•��
Telephone ( ( �� '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /o /3
Fee $ /o
DATE 9 /
• OWNER NAME: P I I
OWNER MAILING ADDRESS: Y60?‹ A a
OWNER PROPERTY ADDRESS: p-v, d' )}s± ) 9- i
OWNER TELEPHONE NUMBER: 37 a x-77_ 4-'0
TAX MAP NO. : Section 2/ . Block g Lot o23
CROSS STREET: et_tr, (70,x0
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing a/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: (pit/ of /Q ,�'
1
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.) - •
id a , 1.
Signature of . pplicant
RECEIVED BY: .0, -
- G ,Clerk's ffice
DATE:
FEB U 9 198
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