HomeMy WebLinkAboutGrathwohl /Vit`__ 11 -Lire _`
JUDITH T. TERRY
�� Town Hall, 53095 Main Road
��� '�:
TOWN CLERK ® f P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Q Southold, New York 11971
MARRIAGE OFFICER
OS ir Fax (516) 765-1823
_®�iLi® 1\11 0'�-
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. 3063-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GRATHWOHL, KENNETH AND WIFE
Mailing Address 1 508 STERLING PLACE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 508 STERLING PLACE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1085
Tax Map No. section 34.00 block 3 lot 29.000
Cross Street CHAMPLIN PLACE
Date Of Last Pump Out 0/00/75
Issue Date: 7/14/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
a -
r
rj„r r1-
I ii',
OFFICE OF THE TOWN CLERK �c�VFFO(r3� ��
C A lication No.
Town of Southold - 0�� ,4.:- r �, �G pp
Judith T. Terry, Town Clerk . ". c y f
Town Hall, 53095 Main Road , -4 7 $10.00 - Residential
P. O. Box 1179 v' Lt ;.; .` $25.00 - Non-Residential
Southold, New York 11971
op' £ .' • ��`�
yo. �,o
Telephone ( Y1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - -- : _ iia --
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE -2// /93
OWNER NAME: 6@�r!0.4., 0a4i- R n,r. cri/ 4 k); ie
, OWNER MAILING ADDRESS: 60g-"S7-6k-ees-iiuG /01. 41c c;
v Li
ir
OWNER PROPERTY ADDRESS: Si4.41sr ,5 41.04,5,, 6
OWNER TELEPHONE NUMBER: /G _ y77 _ to g,s 1
TAX MAP NO. : Section CI Block 3 Lot �7
CROSS STREET: �
TYPE OF SYSTEM: -Septic Tank - New Existing
Cesspool X New Existing x
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 4 R v v ,u o II 7 s
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.)
Signature ofi Applicant
r
IliRECEIVED BY: l,/V/Ca
low Clerk's Office
DATE:
i
' vD .'
h_
.,t J:,
--A—p
L
n nIVI
/ v
-1U) 31
•b S
N
1)