HomeMy WebLinkAboutGraeb z 00
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V) W Town Hall, 53095 Main Road
�® �,i P.O. Box 1179
=_'1 ` 09. Southold, New York 11971
JUDITH T.TERRY -----.,..10,-Ai'
.- ,..10,-�� FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1500-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GRAEB, JOHN
Mailing Address 1 625 EUGENES ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 625 EUGENES ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7397
Tax Map No. section 97.00 block 2 lot 16.002
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/00
Issue Date: 7/25/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'c3\\FFULA'
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ToWn.,�o•f Southold CS _ Application No.
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Judith it. `Terry, Town Clerk rig#
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 tni
� �� , � $25.00 - Non-Residential
Southold, New York 11971 $
Telephone *°/4470-...
• (516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION -
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ \o
DATE SLCL`7 (9 1 So
'OWNER NAME: TO Et-Kt �-127°03 •
OWNER MAILING ADDRESS: /6 E u&t✓ti(-ES i2b
C.crcH6-Lt6 (I 3-3
-
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 73 -73?7
TAX MAP NO. : Section Block Lot
CROSS STREET: 0-0(-(1-G- ZS-
TYPE OF SYSTEM: Septic Tank New Existing _�
Cesspool New Existing 7--
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: LALi g9
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.)
Signat�Y�e o ' •plicant
RECEIVED BY:
Town Clerk's Office
RECERITD
DATE:
JUL 2r 1, .
Tows CIoii Southold
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04/15/90 11: 15
516 727 7218 COMMONIdEALTHLAND O2
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TITLE NO >,• '
�•! , TM_LOGa71Dk OF WELLS AND CLS3PDOL3 SHOwN NEREoN ARt FPOu HELD
_• G ,/ _ • OBSEPVATIONB AND OR FROM RATA OBTAINED FROM OTNERE
_ TM WATK'R SUPPLY ANO St WAGE DISPOSAL SYST{Mb FDR i»q FE3iDLN'.F
WILL CONFORM TO TN( STANDARDS OF TM SUFFOLK cOUHTT pEEARTtl[N
OF HEALTH SERWL(I ,
• APPLICANT,_--- _, _
ADDRESS — ..._- TEL ___-
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LOAM •
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