HomeMy WebLinkAboutDignan JUDITH T.TERRY � ® B Town Hall,53095 Main Road
TOWN CLERK .@0 P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �1 Fax(516)765-1823
MARRIAGE OFFICER \40, �® . Fax
(516)765-1800
RECORDS MANAGEMENT OFFICER i�
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3313-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner DIGNAN, PATRICK AND PATRICIA
Mailing Address 1 11 BROMPTON ROAD
Mailing Address 2
City St Zip GARDEN CITY NY 11530-0000
Property Address 1 LONGVIEW LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-248-1503
Tax Map No. section 88.00 block 5 lot 11.000
Cross Street BAYV I EW ROAD
Issue Date: 3/09/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
"00.
bFFICE OF THE TOWN CLERK I�FU
Town of Southold ���_,.�.T CQIj_� Application No. ' '
Judith T. Terry, Town Clerk .` .." 71
Town Hall, 53095 Main Road $ -� $10.00 - Residential
P. 0. Box 1179 cry , s r `` ' �` $25.00 - Non-Residential
Southold, New York 11971 •O ;. *�`
Telephone :0.( ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 009--e
Fee $ /0 2'
DATE ✓/-e., 3'c9 Met
OWNER NAME: 1' 7'2(CE1_ ekrre cA 9 (PIN
OWNER MAILING ADDRESS: (( i , 240-9,
cloof,s
-
,s err � 1/1
OWNER PROPERTY ADDRESS: L6I4J1.6yi
6b67142-T) , yon- 1/1q-71
OWNER TELEPHONE NUMBER: (6kv? ZL($
TAX MAP NO. : Section g . J1> Block 5 Lot t.O v0
CROSS STREET: (SalYJt (20I
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
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/c7:24-44Vit)
7.44; 71/
Signature of pplicant
RECEIVED BY: AL /i---AJ•7-----kt...e
Town Clerk's Office
DATE:
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N ,/� , I am icmlllar with the STANDARDS FOR-APPROVAL, SUFFOLK COUNTY DEPARTM 1
. if�/A/ CQKf}7RLJCT/ON OF SUBSURFACE SEWAGE FOR APPROVAL OF,CO
^ e�' /1/' : axt�£rSYSTEMS.FOR SINGLE F4M/LY RESIDENCES`.'
�Y e- aNde by the coed/Hon,set forth theiebn and on'Me'- - •
l,l . ` , k ' APPROVED "
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= ti �o° s3;� SURVEY OF
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ve a. �� tie - ao- °� - ,(: ® 1000-88-05-04
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TEST WELL :. Pr. o� I Sept. 28,1994 (foe
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ECEVATAa s ARE REr ERavtED- / •. ' P. O. BOX 909
TO AN ASSt/AED DATUA4 j AREA - 17,500 SQ ft ���own MAIN ROAD
Faw,Da., .-. Sm'ou+ 91i3/9 . ; - - " Ucw=i//gyp ,,,,u /oma+,., SOUTHOLD, N.Y. i