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HomeMy WebLinkAboutKunst EtkPeo- F 1 r JUDITH T. TERRY � ,��' Town Hall, 53095 Main Road TOWN CLERK [ n` T P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER Fax (516) 765-1823 ® to* Telephone (516) 765-1801 �0� 1� !err/ r°/ol" OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1736-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of, Owner KUNST, JOHN AND MARYANN Mailing Address 1 51 STRAWBERRY HILL Mailing Address 2 City St Zip MADISON CT 06443-0000 Property Address 1 COREY CREEK RD AKA KOKE DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 203-245-4732 Tax Map No. section 78.00 block 6 lot 16.000 Cross Street MAIN BAYV I EW ROAD Date Of Last Pump Out 0/00/00 Issue Date: 8/14/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK ' 'S\\FFD(,( C' Town of Southold OQ � - � ' Application No/2-3 Judith T. Terry, Town-Clerk' Town Hall, 53095 Main Road �x^ --,4,7:i 4 -< $10.00 - Residential P. O. Box 1179 cn 34.4 j ; $25.00 - Non-Residential Southold, New York 11971 Telephone Q( • (516) 765-1801 TOWN OF SOUTHOLD • SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. /`7 `36 Fee $ /4•-*" • DATE S- /3 -9 l • 'OWNER NAME: J / at?d / r Qi n / jl-triS-1-- • 1 OWNER MAILING ADDRESS: 51 SfrQw6erre.1 1--k1( Maths. ori C. • 0b��3 OWNER PROPERTY ADDRESS: OW( / Oak. r&IYW iLei (nova) OWNER TELEPHONE NUMBER: (2D.3)a'/S -x/73 X516 ) 765 -LL/53 TAX MAP NO. : Section 7,42-- Block G Lot / • CROSS STREET: ,027Gt-tom / v' TYPE OF SYSTEM: Septic Tank New Existing !/ Cesspool V 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.) / aian16_,(K S• nature of Applicant - - RECEIVED BY: Ai/ / LC-Ase---EA--(__ T wn Clerk's Office DATE: F3 -OV/ --\_ ' '-\,_ ) VW' • t`----_____, .` ' \\'' '\• ' • ' W \------ 1-r,Q6. D 7 LAND I, FpZME L\( VOk N - IA IF Ni2b1D FU,t t N 5/04°4•V SO"b 1 • Is, • 125.00 4 t4.z1 - Q iJ o f 3M IL c� m \\IT. xQ 0 N .— i 9J w , .9. 0 ti. d 4 4 N - If kr 2 Q , �, .1) 1S5 4 -s ^f -petit •- '1 1� , ,..8 o � �O � le34 .. z � �,QyO4a Q 48 v ,-/"3 Irl(04°413'S0"\ J 112.. .00. �.41 1-•p.11D FD12MEQL�( 1,LAI+._ 1,11 F U L.2LLD 1 .6Ls.p .1 SOIsurnaix COT HEALTH DEPARTIE NOV 021978 . A.. Do; a, #_rr a -) DATi� MtP bt= LA1,1p Trter sul,piy 511 „ UpT� i',1,31 acted by`t his C".'opartz.:.nt fl icA.;.d ---,1,-.f,c,..0„..---A- )044-41— a V .0,1 6b1.111-1D1.9 :-,f C., n-7 5z;,•_•'�l:n n.r'i Y2 i3 -11%lt•V NF- hbUl1W l� 7 51..F-Fill.. CDUt X Y, til V. SU711 NED W 2LU 2A ATIto OCT.. ab, 1418 V2.L1414._ U . WV-11.1561\1 , L•5. . .SEINU)4E1 , 1\1`/• IA t../DIME LV- • IADW.ab5ScA‘.-s I"=30'