HomeMy WebLinkAboutDimon „, Town Hall, 53095 Main Road
P.O. Box 1179
•
%00 Southold, New York 11971
JUDITH T.TERRY �� FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1113-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DIMON, CHARLES L. AND BRUCE
Mailing Address 1 LW WASHINGTON AVENUE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 40 WASHINGTON AVENUE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0440
Tax Map No. section 41 .00 block 1 lot 37.000
Cross Street BOOTH PLACE
Date Of Last Pump Out 7/00/84
Issue Date: 5/17/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK .ci\FOur
Town of Southold CQG' Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road a ` ' ' Residential
P. O. Box 1179 v' z' Non-Residential
Southold, New York 11971 O$614: -
Telephone Y►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. J I_I
Fee $ 1,0
DATE_ GAy
Zfped
OWNER NAME:e/j9pfEs_X, ft /g, C6 /mt? (61.11'426")//hp // rim
es pin
OWNER MAILING ADDRESS: ] Lc. nSfrIm.1 '? J go( IUL.eE
G receA1 Pp£ r /• '/ 11 g SLa
OWNER PROPERTY ADDRESS: 46'/902,6
OWNER TELEPHONE NUMBER: ‘74. 17/77-- .04/4/0
TAX MAP NO. : Section 411 Block / Lot 37
CROSS STREET:
TYPE OF SYSTEM: Septic Tank _ New Existing g
j Cesspool New Existin
/
Residential �/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: /4? 0 Lies
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.)
A - �
Signature of Applicant
RECEIVED BY:
RICE: 6=;A Clerk's Office
DATE: �.,
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