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HomeMy WebLinkAboutGrathwohl (2) ////i/ •ice_ II', f .. Town Hall, 53095 Main Road vs) y P.O. Box 1179 Southold, New York 11971 :ZsJUDITH T.TERRY ��`,, 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. 755-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner GRATHWOHL, RUTH Mailing Address 1 MAIN ROAD Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 MAIN ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-6507 Tax Map No. section 109. 00 block 1 lot 36. 000 Cross Street ALVAHS LANE Date Of Last Pump Out 0/00/86 Issue Date: 7/19/88 Judith T. Terry ' Southold Town Clerk (TOWN SEAL) • T I�� OFFICE OF THE TOWN CLERK L/.�'= Town of Southold �O f`� C'OG Application No. 75'5- Judith T. Terry, Town Clerk �` k y 1 Residential r/ Town Hall, 53095 Main Road p. O. Box 1179cr3 ° y hi ; Non-Residential Southold, New York 11971 O' ��` Telephone = j ".0-09 00 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT • APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 7'5 Fee $ /0 DATE • OWNER NAME: Li 'rE T 2{q `11.1) © H-L- OWNER MAILING ADDRESS: M/9 / ftJ RB) a/.1-7--c f1 O (-CI /19,3S' OWNER PROPERTY ADDRESS: tn , (Ai- RDD (i.c.crx\w-o //9 3T- OWNER TELEPHONE NUMBER: 57 - 7 3 TAX MAP NO. : Section /U Block / Lot (3 LLL CROSS STREET: 64. v6 /-is 4/9A) E CCS43;oefe 1-07- TYPE OF SYSTEM: Septic Tank New Existing Cesspool ✓ New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: /76 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.) Sig ature of Applicant RECEIVED BY: Town Cletis Office DATE: RECEIVED ,'(11. 151988 Tin Oterk Southall t _ 62---,--- 0 IN . _ N ( 15,orlE _6 - 6-2opoD 0 ove_Xs \ -). 0 1 ":,