HomeMy WebLinkAboutGrathwohl (2) 1
JUDITH T. TERRY
� .,.>, ,_; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS _ �. -� Southold, New York 11971
MARRIAGE OFFICER
. Fax (516) 765-1823
::> `
'� 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. 1606-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GRATHWOHL, NORMAN A.
Mailing Address 1 305 DEVON LANE
Mailing Address 2
City St Zip SMITHTOWN NY 11787-0000
Property Address 1 295 OAK ROAD
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-265-7611
Tax Map No. section 110.00 block 8 lot 11 .000
Cross Street NEW SUFFOLK LANE
Date Of Last Pump Out 0/00/84
Issue Date: 1/17/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/II
&FFIE OF THE TOWN CLERK sS�FFO(,ir�'-
Town of Southold O CQG' Application No. /(�2,.6
Judith T. Terry, Town Clerk I $10.00 - Residential
Town Hall, 53095 Main Road a, M .
p. O. Box 1179 cn � •:ri �` $25.00 - Non-Residential
Southold, New York 11971 %V. ®_ ' -'4��`
Telephone 0� ��
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
- - OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 2 /2
OWNER NAME: a/if,4N c/e117-81,tiol/L •
•
OWNER MAILING ADDRESS: 36 .5.-- .P -vôit'
SnawroivAyvY / / •787
OWNER PROPERTY ADDRESS: 2 /5 OAK W Gaxp
/l/ v S G<���c � Az y,
OWNER TELEPHONE NUMBER: ( ic) 2 (s — 2 (//
TAX MAP NO. : Section / /0 Block g Lot
CROSS STREET: ��la/ J 14F--rUL le /t/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: / $ V
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.)
1 �lG �d2�r�i
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
40 1
1 I I t
I ! •
_ . �
I
i � f
1 .j
I I ,
- - - - - -----_____ _- f�o. FSSP°°Ls- - - —
II _' I
a_. k, _ _ ,
, . .
.. .
t , , .. .
. . , , . \IN , 1_
1 i i I ,. i i
' , - - I " � '' I ' i
I
•
I I I I •
•
� i
_ 1
0 .I .. k
j i i i - I I fy t
SCC4L_C;' _ f
02 ! / 1r- / .
{ -. �- -'/Il w-S',4-i=g-6z k