HomeMy WebLinkAboutRaab .,G
Town Hall, 53095 Main Road
� ��� P.O. Box 1179
'- al * `�� i•� Southold, New York 11971
JUDITH T. TERRY ������/Poi TELEPHONE
TOWN CLERK (516)7654801
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. 1087-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RAAB, KENNETH AND OLGA
Mailing Address 1 P. O. BOX 116
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 100 TUTHILLS PATH (BAY AVENUE)
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-0958
Tax Map No. section 31 .00 block 9 lot 19.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/85
Issue Date: 4/19/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK c5�� '
FOUrc-
Q
Town of Southold Q Application No. l 6. 8' ?
Judith T. Terry, Town Clerk Fac , A
Town Hall, 53095 Main Road Residential
P. O. Box 1179 ."
�.. : n Non-Residential
Southold, New York 11971 O
TelephoneJird
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
• i
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE W/9/.5---
•
OWNER NAME: � LJ! 11 e,
OWNER MAILING ADDRESS: /% A /Ie
//r.3q
OWNER PROPERTY ADDRESS: leo TU%Hj2 /0,41i311,
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 8 I Block 9 Lot l C7
CROSS STREET: fl9j hE Se T 'TN,GL,S PAR/f
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool _ New Existing
Residential z Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 9
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.)
Signature of Applicant
RECEIVED BY: •
Town Clerk's Office
DATE:
RECEIVED
APR 191989
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