HomeMy WebLinkAboutGrathwohl OFFICE OF THE TOWN CLERK •c.OF()Le&G
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Town of Southold
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Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 8 .rte t
P. O. Box 1179 c
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Southold, New York 11971
Telephone �l
(516) 765-1801 _ '"
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 176 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Mrs. Wilfred Grathwohl (Evelyn)
OWNER MAILING ADDRESS: 250 Oak Road
New Suffolk, New York 11956
OWNER PROPERTY ADDRESS: 250 Oak Road
New Suffolk, New York:
OWNER TELEPHONE NUMBER: 516-734-6125
TAX MAP NO. : Section 117 Block 2 Lot 2
CROSS STREET: Grathwohl Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Approx. 20 years ago.
Judith T. Terr
Southold Town Clerk
DATE: December 11 , 1986
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK •c�uFFO(,r
Town of Southold &,% -, e4-%, Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
� ' , Residential
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P. O. Box 1179 (T1 Non-Residential
Southold, New York 11971 •••�`
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Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /7f�
Fee $ M • 1)P
DATE 43 r�
OWNER NAME: if 5, )44 / frd
079171 '�-
OWNER MAILING ADDRESS: 62 OCO/4-
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OWNER PROPERTY ADDRESS: ,� _ �
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OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 117-. -2- Block Lot
CROSS STREET: _
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing
Residential Non-Residential
- DATE OF PREVIOUS PUMP-OUT: •ea Rs hid • C?)
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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41RAILaiir..4 A
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/Sign. u e of Applicant
RECEIVED BY: �
ammoiQwn CI k's Offi e
DATE:
Town Clapp Southold
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