HomeMy WebLinkAboutDieffenbach OFFICE OF THE TOWN CLERK •c0
Town of Southold - DQ OGy
Judith-T. Terry, Town Clerk ,� :, =<7 rM. '
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971 p ®_ -
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Telephone 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. , 273 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
•NAME OF OWNER: Mrs. P.E. Dieffenbach (Dolly)
OWNER MAILING ADDRESS: Box 412
Cutchogue. New York 11935
OWNER PROPERTY ADDRESS: #6 Fairway Drive
Cutchogue. New York
OWNER TELEPHONE NUMBER: 516-734-6452
TAX MAP NO. : Section 109 Block 5 Lot 14_6
CROSS STREET: Cedar Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Not pumped in last ten years, unknown prior to
that.
Judith T. Terry
Southold Town Clerk
DATE: April 13, 1987
(TOWN SEAL)