HomeMy WebLinkAboutKrogman Town Hall, 53095 Main Road
�O P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY • 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. 646-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KROGMAN, RAYMOND
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Mailing Address 1 P. O. BOX 902
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Mailing Address 2
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City St Zip MATTITUCK NY 11952-0000
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Property Address 1 700 ALBO DRIVE
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Property Address 2
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City St Zip MATTITUCK NY 11952-0000
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Owner Telephone No. 516-298-8736
Tax Map No. section 126. 00 block 3 lot 2. 000
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Cross Street WELLS ROAD
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Date Of Last Pump Out 0/00/00
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Issue Date: 3/08/88 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold .:�� CQ� Application No. &, ��
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road c -'� Residential
P. O. Box 1179 U"2 Non-Residential
Southold, New York 11971 � ®
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: lL
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: -2D6L/� /,,12I UE
LcP 'Ji
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section M6 Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
. 711�2 /,-?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.)
ignature pf Ap icant
RECEIVED BY:
Town Clerk's Office
DATE:
Z
73-