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HomeMy WebLinkAboutStraussner "014 Town Hall, 53095 Main Road P.O. Box 1179 ®�j�® �����i!� Southold, New York 11971 JUDITH T.TERRY =�� ����, FAX(516)765-1823 TOWN CLERK ! �i%/ � TELEPHONE(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. 1321-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner STRAUSSNER, ANTONE A. Mailing Address 1 1111 MAIN STREET Mailing Address 2 City St Zip GREENPORT NY 11944-0000 Property Address 1 1111 MAIN STREET Property Address 2 City St Zip GREENPORT NY 11944-0000 Owner Telephone No. 516-477-0834 Tax Map No. section 34 block 1 lot 16 Cross Street WILMARTH AVENUE Date Of Last Pump Out 6/01/88 Issue Date: 11/29/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) I III 3FFICE OF THE TOWN CLERK �cOFO(,/"- Town of Southold Q O� V Application No. A307,./ Judith T. Terry, Town Clerk ' 0- Ott�► V ~ '- .G $10.00 - Residential Town Hall, 53095 Main Road -. r 3F 4�L�t.f+ P. O. Box 1179 `',. ''- { i • $25.00 - Non-Residential Southold, New York 11971 O a : ' • 'S Telephone 1 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. ,3cy Fee $ / 3 , ,c DATE 19 ``/' /1•4?Cl , v.,,e_ . OWNER NAME: 4/vi / A 5,-----g , diss/ gtr' 4 OWNER MAILING ADDRESS: /1/i / A1is/ -Cr . G'P t�,t</ poR7 Ali/ li f ''l`Az - OWNER PROPERTY ADDRESS: - e� a��' �- -(n6. �� x^�' r� fie'' `s OWNER TELEPHONE NUMBER: -0/6" - 4/7 7—.‹ 2 F-= 4' TAX MAP NO. : Section 4 Block 1 Lot / e. CROSS STREET: A7/%4---04/ 4 ., ,,--H4or, DA TYPE OF SYSTEM: Septic Tank New Existing Cesspool V New Existing V Residential VC Non-Residential DATE OF PREVIOUS PUMP-OUT: el /VL` j'PY.c2 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.) Si7---Z;:z_,'&4AjaZWCZee.i-z-6- 2_, g ture Applicant l RECEIVED BY: _a_./..., C-/ .e., --a) o n CI k's 0 'ice DATE: ///g/ I 'i II I A. A.STRAUSSNER 4 _ - S �� s l 1111 MAIN ST. !c - - - - - + _ —_ GREENPORT,NY 11944 i ill 4.-I-5-- -,-, 1 a / /V -r / A-5t) 9 . l Z �� I ,t". _ _ I . . 9, ; \9 t . ---., _. . _.. _ _. __ _ _,__ _ o . . . . . _ __ , _ , , , ,- , _ _ \ . , 1 , . _ ____ _ . . ___ . _ X:), 4V- 11 7-/YR,)/ ___ _P--,,,,. , ,' .... _ , Fc - , 14 gP0 -f•, c - r ©_�`� - a! ', ti . _ III \r4 A ,n v . , kI e :/\- • ''; ' , - iii . . -