HomeMy WebLinkAboutKuerner OFFICE OF THE TOWN CLERK �� �(�(�`,
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road o
P. 0. Box 1179
Southold, New York 11971 p ® 0�-
Telephone �l
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 120 Residential X
Fee $ 101.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Manfred E Kuerner
OWNER MAILING ADDRESS: 'P.O. Box 408
Peconic. New- York- 11958 ,
OWNER PROPERTY ADDRESS: 2 Carole Road
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2883
TAX MAP NO. : Section 52 Block 2 Lot
CROSS STREET: Old Cove Blvd
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 16-1996
Judith T. Terry
Southold Town Clerk
DATE: November 3,_ 1986
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'(TOWN SEAL)
OFFICE OF THE TOWN CLERK FFO _
Town of Southold ~ o��� �C�� Application No.
Judith T. Terry, Town Clerk
Residential
Town Hall, 53095 Main Road
P. 0. Box 1179 cn Non-Residential
Southold, New York 11971 O ® A
Telephone �.�
(516) 765-1801
TOWN OF SOUTHOLD
Nov 0 3 IN SOUTHOLD WASTEWATER DISPOSAL DISTRICT
®fin CWp� S�.. .."� APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: U
OWNER MAILING ADDRESS: �d
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: x j�- ,��"
TAX MAP NO. : Section 6,2 Block Lot ,
CROSS STREET: a&z-C6"�' C
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 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.)
Sig re of Applicant
RECEIVED BY:
Town lerk's Office
DATE:— ?Io-u
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