HomeMy WebLinkAboutKustes JUDITH T. TERRY L Town Hall, 53095 Main Road
TOWN CLERK ® T P.O. Box 1179
REGISTRAR OF VITAL'STATISTICS s CP �` Southold, New York 11971
MARRIAGE OFFICER � ® ®�
�� Fax (516) 765-1823
•,y®1 J .P oo Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3040-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner KUSTES, JEAN S.
Mailing Address 1 349 FULTON STREET .
Mailing Address 2
City St Zip WESTBURY NY 11590-0000
Property Address 1 MINNEHAHA BLVD.
Property Address 2 LAUGHING WATERS
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-333-1136
Tax Map No. section 87.00 block 3 lot 40.000
Cross Street OWAISSA AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 6/09/93 Judith T. Terr
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c31FF°Orr,=
Town of Southold Q CQ '; Application No.36-`710
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Judith T. Terry, Town Clerk `'} $10.00 - Residential
Town Hall, 53095 Main Road -FA
P. O. Box 1179 *� >. xi ` $25.00 - Non-Residential
Southold, New York 11971 O z O�'1`��
Telephone `j►'a 'o�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPL!CATION - `4`•;,`
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. -
Fee $ •
- DATE 674 3
OWNER NAME: i641) Sd Crusrc
OWNER MAILING ADDRESS: 3 sty /%cj4-72 ST-
CV -S1---(3 0 /1/7- .//-0` o
OWNER PROPERTY ADDRESS: /,0a:f.04.fic*, (?c-c . ( a) /7,f
C) tee , •i �
OWNER TELEPHONE NUMBER: 3—N, —3 3 3— /(3
TAX MAP NO. : Section 17 Block 3 Lot
CROSS STREET: 0(0),(4- CSS a St`
TYPE,OF,rSYSTEM: Septic -Tank - New Existing
Cesspool New Existing X
Residential )L Non-Residential -
DATE OF PREVIOUS PUMP-OUT: 313o /93
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.)
ignature 0- r pplicant
RECE-IV_ED .;BY:
Town Clerk's Office
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DATE: _
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