HomeMy WebLinkAboutKreh (2) O. Q /'
gTown Hall, 53095 Main Road
;y® ��% P.O. Box 1179
._ 06/ �`a®/�� Southold, New York 11971
JUDITH T.TERRY �0�.0idp, TELEPHONE
TOWN CLERK (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. 802-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KREH, MARY E.
Mailing Address 1 P. O. BOX 651
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 MARYS ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8041
Tax Map No. section 107. 00 block 9 lot 19.000
Cross Street WICKHAM AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 8/26/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
III-
OFFICE OF THE TOWN CLERK sSOFULA •
-
Town -of Southold COG_ Application No. e0,0)--
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road •�, Residential
P. O. Box 1179 En 10 4-
,_ � Non-Residential
Southold, New York 11971
Telephone *0104'-'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE (Le(_
OWNER NAME: d2Z1, 1C •
OWNER MAILING ADDRESS: �(�� �D,� ��� — ?ii.„4-12-161- > 4'
9 �Z
OWNER PROPERTY ADDRESS : ///I
OWNER TELEPHONE NUMBER: 6— -- 3-67 7/
TAX MAP NO. : Section tO `7 Block 9 Lot •
CROSS STREET: W 101c), h rn _
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool Z New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: fe...--6-6 /j / 77P l-• -7-1 t4
v
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.)
•
*L`re �A„
Sign re of Applicant
RECEIVED BY:/ t � . atJ
Town • erk's Offi e
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DATE:
AUG 26 19