HomeMy WebLinkAboutKull ,11td��IrL"ii'.�
OSA LALfre-;
Town Hall, 53095 Main Road
P.O. Box 1179
® Southold, New York 11971
JUDITH T.TERRY - `� '`�� FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 1435-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KULL, ROBERT AND PATRICIA
Mailing Address 1 DICK'S POINT ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 DICK'S POINT ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5206
Tax Map No. section 110.00 block 2 lot 14.000
Cross Street PINEWOOD PLACE
Date Of Last Pump Out 0/00/00
Issue Date: 4/04/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cOt
Town of Southold n 4` .1 Application No. / ,.3,5Judith T. Terry, Town Clerk � 'x}"' y
~ 4 $10.00 - Residential'
Town Hall, 53095 Main Road
P. 0. Box 1179 Cr) - y°�
til; �='�At� � $25.00 - Non-Resi�€ential
Southold, New York 11971 O ® =,;fir.
Telephone _(i 1"°;-
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee—$14-1-1 Oa
DATE 2 Ci
'OWNER NAME: U I -Pv ) -1 r.9Tr.' C% LaLv '
•
OWNER MAILING ADDRESS: D. cg oT Xrj
OWNER _PROPERTY ADDRESS:- `,vN G Ji -0�-j 4.4 103r--
U
OWNER TELEPHONE NUMBER: A76, . 7 3 if r 31 O
TAX MAP NO. : Section f ) 0 Block Lot I vl
CROSS STREET: P: N , t„, 00 j 4. (1).- pf
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.)
P''\'' " e
co
FIZI)
Za`1i,' L. ` � Signature of Applicant
RECEIVED BY:
Town Clerk's Office
UcJ as
DATE:
APR 02 19
t.'