HomeMy WebLinkAboutGroblewski 40' ci§VOUr ;
14 ® x�N9
�, „ Town Hall, 53095 Main Road
JUDITH T. TERRY
TOWN CLERK N r„ P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS ``, Southold, New York 11971
23
MARRIAGE OFFICER Trtl Fah (e (5 765-65-1
• 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. 1731-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GROBLEWSKI, KARL
Mailing Address 1 780 BEEBE DRIVE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 780 BEEBE DRIVE
Property Address 2 •
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5999
Tax Map No. section 97.00 block 7 lot 11.000
Cross Street EUGENES ROAD
Date Of Last Pump Out 0/00/00
~
Issue Date: 7/29/91 Judith T. Terr
Southold Town Clerk
(TOWN SEAL)
III
OFFICE OF THE TOWN CLERK c�vFF17(,(�'-
Town of Southold /
Q�� ,_:� CQG•; Application No./73
Judith T. Terry, Town Clerk �� x- `) $10.00 - Residential V-
Town Hall, 53095 Main Road
P. O. Box 1179 ar '4:' *t �` $25.00 - Non-Residential
Southold, New York 11971 ,4 ' , �S
Telephone _ q .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT •
SEPTIC TANK or CESSPOOL
Operation Permit No. l Z3/
Fee $ /0.oO
DATE 7- ON 4j
OWNER NAME: kairi lbb//thJki
OWNER MAILING ADDRESS. gv• 2r)vt_Ii gas'
OWNER PROPERTY ADDRESS: C
OWNER TELEPHONE NUMBER: 1/--(51V9
'
TAX MAP NO. : Section ( 7 Block -7 Lot //
CROSS STREET: ForkS
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential V- Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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 c ' -st road.)
qll ' aoler--'''
. .I A 1/.4 1 ht:_s., .__<,......e' _ 9
`-- rturr of Applicant
•
RECEIVED BY: Atlf---1-61 .1 .
Town Clerk's Office
DATE: 7... �7--F/
i\k-rk:Lo+ Hurnbers shown ref-Cr •t-o
"Mab Of Moose Cove. f led itr
+he Su-Folk C�c1r.tc j Cler
KJ 0,3--ice •
-- 0'5 Ma/ No. 2 F0 A///
1J•� r ..� Li r J
., # C
2`' 5^ t
---
7-Ci"
'varcarri) ~'
I Tei' r=ole
ti
"C• • �3 N.-7 .'5"0"20"E:. — 15Q.0
8
Z (11
1
( 0
18
1 f 0 Tarra7e \ /house
4Z0 46 \sem j2` m
• 1' r, cb to T' •a
---Q•— : --
ogl
�y
T �, `�
1 !l
6 .
43
1A O -r
52 �
'2?7,
--;. I
r.----
i
z. —�" s.� r
Ni_______.. _\ , 0
N /
O.
\
4'�\-&
�pw t �dde
�rA + �housej
o
(ora 1
'22: \ \ ?ft
i_. . ,
•. \ 7
..e) -