HomeMy WebLinkAboutGrippe 1,,ste gLir e
Town Hall, 53095 Main Road
P.O. Box 1179
�� Southold, New York 11971
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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. 795-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner GRIPPE, FLORENCE & PETER
Mailing Address 1 BOX 244
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 28100 MAIN ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2694
Tax Map No. section 18. 00 block 6 lot 22. 000
Cross Street NARROW RIVER ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 8/19/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK • c�vFFO(,(�C'G
Town of Southold Application No.
Judith T. Terry, Town Clerk k-, ,». y
: N. L 1 Residential V
Town Hall, 53095 Main Road r��z•'
P. 0. Box 1179 to .114,1 41
<��"� i Non-Residential
Southold, New York 11971 O 0� ���`
Telephone *1:1*--- �� '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: Florence & Peter Grippe
OWNER MAILING ADDRESS: Box 24,/4.
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OWNER PROPERTY ADDRESS: 28100 Main Rd
Orient NY 11957
OWNER TELEPHONE NUMBER: 516 323 2694 r `
TAX MAP NO. : Section 18 Block 6 Lot 22 ,Y
CROSS STREET: Narrow River Rd
TYPE OF SYSTEM: Septic Tank New Existing
•
Cesspool x New Existing x
Residential Non-Residential
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DATE OF PREVIOUS PUMP-OUT: June 14 1988
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.)
AriQN,
Signature f •(. 1icant
RECEIVED BY:
RECEIVED Town erk's 0 f ce
DATE: AUG 1919:
Town Clerk Southold
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