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JUDITH T. TERRY ; 1► Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER 1 O�' Fax (516) 765-1823
=_'y � Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2084-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DIEFENDORF, ELIZABETH
Mailing Address 1 1177 EAST NEWPORT ROAD
Mailing Address 2
City St Zip LITITZ PA 17543-0000
Property Address 1 280 MEADOW LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 717-627-3993
Tax Map No. section 115.00 block 4 lot 24.000
Cross Street NEW SUFFOLK AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 3/23/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c0FO(,r���
C' A lication No. U
Town of Southold �� QG pp a2,
Judith T. Terry, Town Clerk . ` fr
Town Hall, 53095 Main Road x w`",.: i $10.00 - Residential
p. O. Box 1179 v' s '' �` $25.00 - Non-Residential
�: ��..
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 7- 3
OWNER NAME:
OWNER MAILING ADDRESS: /7 '77 .C. Vee_e./4 o,e 2d
1 /9% / 76--,z3
OWNER PROPERTY ADDRESS: —2-8c) / -eUe
OWNER TELEPHONE NUMBER: 7/ 7- 7— 399'
.0A--
TAX
-TAX MAP NO. : Section //S... Block -4-- =D-l-,2Lot s/ (Y-- So
CROSS STREET:
. TYPE'OF'-SYSTEM: Septic Tank - New Existing
Cesspool New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: (A/ i,'0
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.)
1/
36 A2-0
J� l/ fap
Signature of j . licant
g
RECEIVED',BY: _
Town Clerk's Office
DATE:
e
YOUNG YOUNG
400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
. R = 570.00'
• ALDEN W. YOUNG HOWARD W. YOUNG •
7RORg8810NAL BNOIM RAND - LAND 'SURVIVOR '�$ I
LAND SURVIVOR. N.Y.B. LIC. NO. !2248 N.Y.S. LIC. NO. 49891 '
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.ice SECTION 7209 Cf iN£NF':i YORK STATE
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to 2",,,,e_ _ ' i �~ "�-! TUTION.GUARANTEES ARE I.OT 7AAMSfEAA9LS
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`•= u J z' SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK '
C �-- "1 OF SUFE. CO. ON SE PT.8, 19Fr5 AS MAP NO. 4453.
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APR. 25 1980 �_
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