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HomeMy WebLinkAboutKrom �_ iii• JUDITH T.TERRY 11/1 t�` Town Hall, 53095 Main Road TOWN CLERK ; P.O.Box 1179 yy. T � Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(516) 765-1823 MARRIAGE OFFICER \y� _,%N• 1 ftECORDS MANAGEMENT OFFICER Ol � ID-at 0 Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER �•,,,,,.• � OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3467-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner KROM, LAURIE Mailing Address 1 P. O. BOX 545 Mailing Address 2 City St Zip LAUREL NY 11911.8-0000 Property Address 1 1280 PECONIC BAY BLVD. Property Address 2 City St Zip LAUREL NY 11948-0000 , Owner Telephone No. 516-298-9465 Tax Map No. section 145.00 block 2 lot 12.000 Cross Street LAURELWOOD DRIVE - Issue Date: 5/16/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) • : •", tF 3 / ` / OFFICE OF THE TOWN CLERK F[Air '' Town of Southold , • CQApplication l�llir i—' Judith T. Terry, Town Clerk .� . • •: 1,4„:4%) Town Hall, 53095 Main Road $10.00 - Residential 31' P. O. Box 1179 U' �` $25.00 - Non-Residential Southold, New York 11971 O 0-le" �`� Telephone 0 * (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE -5-' / - /p _ OWNER NAME: L et Kr OWNER MAILING ADDRESS: Q r I3 off' 9 �.4�t ,V/• 7/ 94IJ2 OWNER PROPERTY ADDRESS: / c2Q V Pe cor,-r` C, /� A )4' 01 a• i e- I, ply . //9' OWNER TELEPHONE NUMBER: 57 - o`zcf f- 9.516 S— j TAX MAP NO. : Section � �D � Block Lot /)--- CROSS STREET: Lo tire.. /wood ) r-1 ✓e_ TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential Non-Residential 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: ' ''''''7,' ''''' '''' ' '7`-'"- : • : ',A:„ „,.A.,-",-,,,,,,,.*-_, '''. '' -,'''.- ' '',.-„4,- ,°„.r, °.,:°.,,,, , ' , 'i:°:P.`1,-,1 '4,.., •'i, - ... - , 0 ,..„,I •:-., '..•'. .:0'._:*:;-..--4,1-._r,-,,.: y0 I ,........,. ....41-a: . °, ..,-",....... i .•- ''' *. " '`,, ,,,•.-, ."'O'V'''' 2 '' '''''f,' +t 4.- A i:,',, 4k-,7: '''''',, - . .:4:t ,4.,1."",4r4r-e•41't '4 r.,,, ;.-----,..,,'fi-e":',,,.,..,‘''''" ,_ ' C'?„--___,___.__------ --1- --1-- ' ='''' ..'+, •,i-•'- --w - ----ER- -.44,4 - ---- ''',S. '''' ---— - ' -.z,..,'...,- 2' 1 ..0 191::`)– — ' •-.S. ;'4,-.4f-r"..,- -,_:.- ,w,,. - --•.- •) i ---a,• ,tv ,, _ _ _ _ ... _ _ o , - 5--4_4__4_ SCP . ......j4 --' --77 ,,- - _ — \ / \,\TANer -2 I G'i'--, • Cfr...,1.: - ° _ - ___ _,....:- - c L!RBF- ___.___.`E. ,... .,_,., .... ,,, N / _..„ ' I . , 1 .--__:Lik: TE . . ( • C.5‘ N 1 . 1 t CO t4C1t1 . 1 ' VI-'...,EsON ,___- . -- ,.. , --. I Pi:•,RI.INiG i -- ---1. ,,,,,_4____i -- _ ....— - - --. A';,f) — t . .-,s US C---- I i- -' c'') • 0 it\N IN LAU 17,1 E IeLr2C V: r. -- , \ 111 0 ---- c... c._ C - 0 , -f-c327 S.F. . , - , ('N T T,t_At..-1-E _ ---- _ _ ( ;71 in 1 C' _ --57 rooF LINE r i ‘ ' ' '. '--717--- - ' •/--c-- • - - .0. _____ 00 1.).2.? 4.4 z--,c,. ',,,,/ s • --k C.' _,.....-+ , V. — , '1, -C• l - cN MAP CJF Pi \ . .. , ..., \ \ 5 U12.VEYE ,. ..., ANd 1\1 LA, -----::::- / , . -......,._,.., CA L E - 30 , . ....., A = ; ..._, ..., , 0 7 Pil'7'P\i I.)M F: •:..-"-- --_,... LA t.s r ------:_... —,-AkiN OP sr-- ,.., . ... ..----