HomeMy WebLinkAboutBruns T FFOb /9'
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rTN Town Hall, 53095 Main Road
v'® N St P.O. Box 1179
4f6° � ��i� Southold, New York 11971
JUDITH T.TERRY „�r�rrr�� FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1544-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X,
Name Of Owner BRUNS, LEONARD AND JOAN
Mailing Address 1 4 GREENLEAF ROAD
Mailing Address 2
City St Zip NATICK MA 01760-0000
Property Address 1 235 MARRATOOKA LANE
Property Address 2
City St Zip MATTTIUCK NY 11952-0000
Owner Telephone No. 508-653-1372
Tax Map No. section 115.00 block 4 lot 1.000
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/79
Issue Date: 10/03/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
�� ��� •
OFFICE OF THE" TOWN CLERK SWFOCA-
Town of Southold �O , CQG' Application No./5q�
Judith T. Terry, Town Clerk . ,'` fi � :�
Town Hall, 53095 Main Road 8 -� : $10.00 - Residential ✓
P. O. Box 1179 k r �` i -
cn ��- ,..;,err,..
Southold, New York 11971 ,� $25.00 Non-Residential
Telephone .ifft ��� •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ J r
® .
DATE 10 -- -
- _ OWNER NAME: -JO •9-dt) L- 3J LED10 A-Zt7 E_ e,itr.7 S
OWNER MAILING ADDRESS: C2e�rn Koc
O� ICK S ®t`7 ( 0
OWNER PROPERTY ADDRESS: A 3S PA 01—m4, �} I.�q a� _ 4 .
Mfl--1Lr, TUe K L ,_ J 1 19 sm.--
OWNER TELEPHONE NUMBER:( D') (o53
TAX MAP NO. : Section '
H Block 014 Lot £
CROSS STREET: C n� � 1 Gea.�-�r �� • i ! �� 'e
k+ as- vie '4.V� -oI�1 slew1nS1� .Pore.
7-001(\61 revs 1 ''�,,t:+mei Vorimi.
TYPE OF SYSTEM: Septic Tank New Exising ✓
Cesspool New Existing t/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT,: 7_ — fiO_n nett 6.)2nr1 eQ.
bet-Ail 4-0
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet 161o
of distance, approximately, to building and closest road.)
_goo
ignature of Applicant
RECEIVED BY: -
Town Clerk's Office
DATE: RialVID "
OCT 0'6 19
Bowe Clavi o OM