HomeMy WebLinkAboutKuhlman OFFICE OF THE TOWN CLERK F�
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road o 1
P. 0. Box 1179 cn g
Southold, New York 11971O�-
Telephone
(516) 765-1801 \�
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 147 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Thomas Kuhlmann
OWNER MAILING ADDRESS: 2205 Sigsbee Road
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 2205 Sigsbee Road
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-9440
TAX MAP NO. : Section 144 Block 2 Lot 21
CROSS STREET: Peconic Bay Blvd
TYPE OF SYST-J=M: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: July 1 , 1986
•
Judith T. Ter
Southold Town Clerk
DATE: November 14, 1986 Z
(TOWN I SEAL)
OFFICE Q,P THE TOWN CLERK �FFO
Town of Southold 0��� QG Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road c Residential
P. 0. Box 1179 v' 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. /4/7
Fee $ 16
DATELI'3Ly�
OWNER NAME: // �' -S �`/ L A//7 /
OWNER MAILING ADDRESS: J
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 2-- 7 SZO
j TAX MAP NO. : Section Block Lot o2
CROSS STREET: ACzL'
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: ou 4
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately,__to__bu_ilding and closest_road.)
1
Signature of Applicant
RECEIVED BY: Ce4_'1 11
TownClerk's Office
DATE:
NOY 14
'down Clark SouthOld
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