HomeMy WebLinkAboutKuck OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk J'
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971 p ® �-
O
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 160 Residential . X
Fee $ 10.00
Non-Residential
.
Septic Cesspool X
NAME OF OWNER: Harold E. Kuck
OWNER MAILING ADDRESS: Box 297
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Bartley Road
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8122
TAX MAP NO. : Section 143+ Block 3 Lot 27
CROSS STREET: Bay Avenue
TYPE OF SYST-EM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT:July 1986
Judith T. Terry
Southold Town Clerk
DATE: December 1 , 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold ��� CSG Application No. l�
Judith T. Terry, Town Clerk h ��
Town Hall, 53095 Main Road -� ` Residential
P. 0. Box 1179 U' Non-Residential
Southold, New ""York 11971 O
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: C—
OWNER MAILING ADDRESS:, 9-- 11
OWNER PROPERTY ADDRESS: 13C�
OWNER TELEPHONE NUMBER: Gj
TAX MAP NO. : Section q2 Block �j Lot
CROSS STREET: 3P� / //��/�/ G/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspools New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
!mss 2'� (�-- I&zk
Signature of Applicant
RECEIVED BY: O-L--�'
Town C rk's Off'ce
DATE: QpCoVED
DEC 01199
Town CWrh Southold
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