HomeMy WebLinkAboutDimig Ctt "VIN
JUDITH T. TERRY $ ‘#A:41 Town Hall, 53095 Main Road
TOWN CLERK �, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
Mei O ' Fax 765-1823
MARRIAGE OFFICER / �',�4F516( )
!® I�.4i.0 Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1956-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DIMIG, KARL F.
Mailing Address 1 1015 BUNGALOW LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1015 BUNGALOW LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5917
Tax Map No. section 123.00 block 3 lot 13.000
Cross Street CENTER STREET
Date Of Last Pump Out 0/00/00
Issue Date: 8/14/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
4- -
•.i
OFFICE. OF THE TOWN CLERK 'c�VFFOCA-
Town of Southold �� CQG Application No. /,
•
Judith T. Terry, Town Clerk Y r
� rte;" �r +�: r•C 7 $10.00 — Residential
Town Hall, 53095 Main Road ?
P. O. Box 1179 cn '. ;' $25.00.- Non-Residential
Southold, New York 11971 O � k1.,-(Telephone j 0+;$:
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE F'// 6
OWNER NAME: ie.-- . 0 „i,/ // /i77,/r
/).„
OWNER MAILING ADDRESS: `/i (//1,7S(9,4 c2C/
77 7-'c l/, iii st • //9,<"2- -
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: c).., 9F,----..5".91 / 7
TAX MAP NO. : Section 40,C:4- 8 Block 3 Lot
CROSS STREET: OP/7/7-0 S-77--kee-T
TYPE OF SYSTEM: Septic Tank New Existing /
Cesspool New Existing C/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1-6%�/0jl/ ✓ r' , t
/ -
LOCATION MAP: Must be attached hereto before per i may •e issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
/ u `
Signatu•e of Appliwant
RECEIVED BY:
Town Clerk's Office - - - -
DATE:
1/
04 ' �+ -
3/
1,4
g0A
11111
X�'
goseT's'