HomeMy WebLinkAboutKreh /40fULtAC
Town Hall, 53095 Main Road
.��'. P.O. Box 1179
oltNC ®��'� Southold, New York 11971
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JUDITH T.TERRY ®� i%�) TELEPHONE
TOWN CLERK < �zij## (516) 765-1801
REGISTRAR OFF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 874-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner KREH, JAMES
Mailing Address 1 2950 CAMP MINEOLA ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2950 CAMP MINEOLA ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4929
Tax Map No. section 123 . 00 ' block 5 lot 5.000
Cross Street KRAUS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 10/05/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c0Fau.�'-
Town of Southold �� CQ/4,,A' Application No. g17171Judith T. Terry, Town Clerk ,` ': t
Town Hall, 53095 Main Road '� kResidential
P. O. Box 1179 cn ih=- t _* z Non-Residential
Southold, New York 11971 �y�o n
Telephone '_ .�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
--
DATE lam/ /E-el-
- OWNER NAME: li/�L� e I7
OWNER MAILING ADDRESS: Ccv-Y)/ c,%; CA-?Y0
7777%---(. /L)
OWNER PROPERTY ADDRESS: 5,q--,y,,L
OWNER TELEPHONE NUMBER: t
TAX MAP NO. : Section /9 3 Block `j Lot S
CROSS STREET: Fi//
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing A
Residential Non-Residential
DATE OF PREVIOUS PUMP-OU : ///— 7 <-7
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.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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