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JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK G T • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS c.rs Southold, New York 11971
� Fax (516) 765-1823
MARRIAGE OFFICER O ®�
Itv 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. 3036-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KRAPF, ANN
Mailing Address 1 P. O. BOX 128
Mailing Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 2070 GRATHWOHL ROAD
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-734-5924
Tax Map No. section 117.00 block 2 lot 14.000
Cross Street GEORGE ROAD
Date Of Last Pump Out 0/00/83
Issue Date: 5/25/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I„
OFFICE OF THE. TOWN CLERKOFO
Town of Southold � r �CQ Application No. 3 6 3F
• Judith T. Terry, Town Clerk p Y 4t' s .�►
Town Hall, 53095 Main Road
< 1 $10.00 - Residential
P. O. Box 1179 u34zti f'} 'moi ; $25.00 - Non-Residential
Southold, New York 11971 �
Telephone _?1�.P 0 'I
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE I, g' 93
OWNER NAME: NI raft)
OWNER MAILING ADDRESS: P1 i . 46OX 1028'
SuQE/o 1, my, // 95- i
''OWNER PROPERTY ADDRESS: 21 70 GYVM iUdA/
lel �gi I'll rF®L/ Nye i/13 S
OWNER TELEPHONE NUMBER: 1,3(j--- ,c9029
TAX MAP NO. : Section in, Block g, — e Lot /1/
CROSS STREET: Galh 010/// Rd.
TYPEI OF SYSTEM: Septic Tank New " Existing
Cesspool New Existing
Residential 17 Non-Residential
DATE OF PREVIOUS PUMP-OUT: a'6-evil,( /7137 /9 79 ?
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.)
dam? /4
r _
Signat fre{of Applicant
RECEIVED BY: _
Town Clerk's Office
DATE:
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