HomeMy WebLinkAboutKren Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERIC
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1134-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KREN, 'ALBERT P. AND WIFE
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Mailing Address 1 P. O. BOX 238
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Mailing Address 2
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City St Zip ORI-ENT NY 11958-0000
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Property Address 1 THREE WATERS ROAD
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Property Address 2
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City St Zip ORIENT NY 11958-0000
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Owner Telephone No. 516-323-3525
Tax Map No. section 15.00 block 7 lot 10.000
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Cross Street U H L LANE
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Date Of. Last Pump Out 0/00/00
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Issue Date: 6/05/89 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK S�FFO(,�
Town of SoutholdCPG Application No. )
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road' a I Residential x
0
P. 0. Box 1179 v' Non-Residential
Southold, New York 11971 O
Telephone(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
IJ7
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $/ O
DATE A I�ZL
OWNER NAME: q
OWNER MAILING ADDRESS: ,
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: ✓�� -- �L�r�� c�
TAX MAP NO. : Section Block Lot
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CROSS STREET: ivE rAJ A" p,6'72 20 A, D)
TYPE OF SYSTEM: Septic Tank-- Ne xistin`g
Cesspool Newer Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: A -VP iM r-
✓ ,gAY
LOCATION MAP: Must be attached hereto before permit may be issued. J
(Locate building and system; give north arrow and feet
V - ,i -s of distance, approximately, to building and closest road.` -
S,5 CjJ �s ITS E,
TH 7-16 IF
/&,'CVAA4I7-M Al 0Signa uce of Onn t
RECEIVED BY:
Town Clerk's Office
DATE:
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