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HomeMy WebLinkAboutKrause wiir "Aal l Town Hall, 53095 Main Road 4 ®�'��`' P.O. Box 1179 ` �� ��0'I. Southold, New York 11971 JUDITH T.TERRY `fir= 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. 1002-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner KRAUSE, CHARLES M. Mailing Address 1 P. O. BOX 85 Mailing Address 2 City St Zip GREENPORT NY 11944-0000 Property Address 1 MANHASSET AVENUE Property Address 2 City St Zip GREENPORT NY 11944-0000 Owner Telephone No. 516-477-0863 Tax Map No. section 43.00 block 1 lot 2.000 Cross Street ANGLERS ROAD Date Of Last Pump Out 0/00/00 Issue Date: 2/07/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK OFOC,'.'` Town of Southold % ea,: , Application No. /04 Judith T. Terry, Town Clerk �`1... )-•::-'!: 4'M-l - Town Hall, 53095 Main Road • -< Residential P. 0. Box 1179 cry ,. ' >r '' • tri ;' Non-Residential O 'y Southold, New York 11971 - ' •0.��`, Telephone 0 1� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • • DATE h 4 OWNER NAME: a/' //,41-4)/i--.5 ,a, e,914,2:- OWNER ,914 -5 2:OWNER MAILING ADDRESS: Re', 3 e,)( 88 G.f ,tNP 4 141/ 1/9 OWNER PROPERTY ADDRESS: �/.1%,iy, ,¢S,S')•= / ,4/'&, ;�,,471(p©/e T—A/y, OWNER TELEPHONE NUMBER: 5// _ 4/ 7 e7 8t63 • TAX MAP NO. : Section U 3 Block l Lot ; CROSS STREET: ", ---'-'-'7:'-/----: -- _ _c,_ _- 74_d-- __ '- ;i i TYPE OF SYSTEM: Septic Tank New Existing Cesspool ' 1/ New Existing Residential t/ Non-Residential DATE OF PREVIOUS PUMP-OUT: /02/c3.9/?8' • 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.) ") " ---1e/--1---e••-e__--- Signature of Applicant RECEIVED BY: / t(}/(--e4- ----- Town Clerk's Office • DATE: 6 / N