HomeMy WebLinkAboutDietrich • -,.3.3 IJ (.
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Town Hall, 53095 Main Road
1.V. 1�� P.O. Box 1179
M.
.�. / Southold, New York 11971
JUDITH T.TERRY „o,
i/0ll TELEPHONE
TOWN CLERK (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. 731-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner DIETRICH, ROBERT & VIRGINIA
Mailing Address 1 BOX 64
Mailing Address 2 NORTH ROAD
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 NORTH ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2105
Tax Map No. section 44. 00 block 1 lot 15. 000
Cross Street ALBERTSONS LANE
Date Of Last Pump Out 7/31/86
Issue Date: 6/13/88 Judith- T. Terry
Southold Town Clerk
(TOWN SEAL)
F!rb'�
OFFICE OF THE TOWN CLERK �rO /
Town of Southold �� s <: C�l Application No.7�
Judith T. Terry, Town Clerk "'
Town Hall, 53095 Main Road
o. Box 1179 5o Residential ✓
P. ' ''r =r � Y . Non-Residential
Southold, New York 11971 ""
Telephone :4/1 0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 7d
Fee $ /0
—
DATE ,L,c,i4 s 9/ a
OWNER NAME:
OWNER MAILING ADDRESS: if ' �!/ /� � /41=9-1 '
- 197/
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: (674 ) 2C .2 /0 „r-
TAX
2l0 „r-TAX MAP NO. : Section * Block / Lot / /� o
ROSS STREET: /i ' ! ` i
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing ✓ .
Residential �� Non-Residential
�
DATE OF PREVIOUS PUMP-OUT: 7 -- 3 f -- eS i (�
LOCATION MAP: Mu,.t 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.) /3//C- '
ignature of Applicant
RECEIVED — 0
•` z "``Town Crrk's Off ce
DATE: JUN 131999
Town Clerks South
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