HomeMy WebLinkAboutNorkelun v�Ff01_Ce
11 C:m
�s Town Hall, 53095 Main Road
�_k 1� P.O. Box 1179
_ ,i' Southold, New York 11971
JUDITH T.TERRY 1 --iso
�� ,�� FAX(516)765-1823
TOWN CLERK 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. 1261-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner NORKELUM, HARRY
Mailing Address 1 P. O. BOX 106
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 SKUNK LANE
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-734-6869
Tax Map No. section 97.00 block 4 lot 4.000
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/00
Issue Date: 10/11/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE THE TOWN CLERK 'c.3\\V
OFFICE
of Southold Q • C'� '• - Application No. /02/6/
Judith l Terry, Town Clerk ;
Town Hallr 53095 Main Roadafg �: ,� -� I $10.00 Residential
P. 0. 'Bnx '`1179 � ` � ,,_ -
ii�.
� � s_r�; �� $25.00 Non-Residential
Southold, New York 11971 O ..� `'
Telephone _le( -)\-6
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE (Reid-- $7
OWNER NAME: //17 Q7 •
•
OWNER MAILING ADDRESS: /0,0,60( /o4 P�coP4 , e ,Y� //Pv8
OWNER PROPERTY ADDRESS: oO/YI< Almy
OWNER TELEPHONE NUMBER: 731 loS 7.6
TAX MAP NO. : Section 17 Block Lot I/
CROSS STREET: )'o '7` Y
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 7. Non-Residential
DATE OF PREVIOUS PUMP-OUT: /U6, /4 Yp
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.)
ignature of Applicant
RECEIVED BY: A-t -y_a_c-
Town "Clerk's Office
DATE:
OCT101989 .
Ton Clerk SouttioiJ
)1A/ 0
� G
_. .;\'-60-61-