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HomeMy WebLinkAboutGrigonis (3) ' /IIIii.�i `� Town Hall, 53095 Main Road ��� P.O. Box 1179 �� ' Southold, New York 11971 JUDITH 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. 691-R Residential X Non-Residential Fee $ 10. 00 Septic Cesspool X New Existing X Name Of Owner GRIGONIS, RICHARD Mailing Address 1 2225 KENNEYS ROAD Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 2225 KENNEYS ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-3241 Tax Map No. section 59. 00 block 7 lot 8. 000 Cross Street CHESTNUT ROAD Date Of Last Pump Out 0/00/00 Issue Date: 5/05/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) GFFICI. OF THE TOWN CLERK cuFFiti' = Town of Southold CQ '_, Application No. 6' 51 Judith T. Terry, Town Clerk . Town Hall, 53095 Main Road 4_ Y�. Residential ! P. O. Box 1179 cry ' % Non-Residential Southold New York 11971 - -�` Telephone .i4 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /Q DATE OWNER NAME: A,,e r ed C (3 6 a ) OWNER MAILING ADDRESS: Awa S �� �-� n e L S Pc,cc ' it - e o4c OWNER PROPERTY ADDRESS: 5prne R-5 14 boo OWNER TELEPHONE NUMBER: '7(, Fj . )-t / TAX MAP NO. : Section 5 Block 7 Lot CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: 5-, 3- 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.) is atur-o . . icant RECEIVED BY: -, -e ' Townrk's ice DATE: I • 1L . _ _ - - . - , _ _ _ . _ . __ .4. ‘k,_ e, .'-) e 5 I� Cl - - U -,__ _ . g_ -- - -- - - --- ---- - - - - - .. _ _ ._,. .4_,if , „....../L„, v . /0 re_ t_ .„,_„___ . p,,,i, _ _ _ , . _ _ _ _ . _ , . _ . . ._ __ 0 _ . _ _ . _ _ _. _ ._ �. _ _ � -- log . . . . . _ . _ _4_ , _ , , , > 0 _ _ __ __ _ _ _ _ _ . . _ _ ._ ,._ _ _ _ _ ._ , .. „ _ ____ _ . . _ _ _ _ _ _ _ a.. ..... _ _ ....„. ._ , ... . . . _ . . . . ••,_ , . _ __ , _ housc_- - _ 1 0, ___ .. . . . . _ . _ . . . . _ . - - - -- -- - - -- -- - -is - - -