HomeMy WebLinkAboutKaelin OLt
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Town Hall, 53095 Main Road
t''-••,_V' `V- ' P.O. Box 1179
`a/••� Southold, New York 11971
JUDITH T.TERRY �'��~,,, /0- TELEPHONE
TOWN CLERK (516) 765-1801
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. 71-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner KAELIN, DANIEL A. & W.
Mailing Address 1 KAELIN' S SERVICE CENTER
Mailing Address 2 P.O. BOX 925
City St Zip CUTCHOUGE NY 11935-0000
Property Address 1 ROUTE 25
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5804
Tax Map No. section 97 . 00 block 5 lot 3 .000
Cross Street COX LANE
Date Of Last Pump Out 0/00/00
Issue Date: 6/29/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
II
OFFICE OF THE TOWN CLERK c15,FOf'K
Town of SoutholdGq; Application No.ALC 1/
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road t.4 �x` n=. : Residential
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P. O. Box 1179 •
> ' ta ,ai Non-Residential 4/
Southold, New York 11971 ® � �� ��''
Telephone .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /414
Fee $2 5.00
DATE June 2%1988
Daniel A Kaelin & W
OWNER NAME: Kaelin' s Service Center
Route 25 & 8oK Lane , Cutchogue,N.Y. , 11935
OWNER MAILING ADDRESS: P.O .Box 925
OWNER PROPERTY ADDRESS: Route 25 & Cox Lane
OWNER TELEPHONE NUMBER: 516=7345804
TAX MAP NO. : Section 97-5®3 Block Lot
CROSS STREET: C O )( 4: J�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: May 10,1988
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.)
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Signature of Applicant
RECEIVED BY:
RQvaown Clerk's Office
DATE: ,u10 29 1988
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