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HomeMy WebLinkAboutDittman diefotilArreo JUDITH T. TERRY e Town Hall, 53095 Main Road TOWN CLERK =!) P.O. Box 1179 REGISTRAR OF VITAL STATISTICS (!fil Southold, New York 11971 MARRIAGE OFFICER Fax (516) 765-1823 $N® ; Telephone (516) 765-1801 =_._ dam %� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1999-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner DITTMAN, BARBARA J. Mailing Address 1 1635 SMITH ROAD Mailing Address 2 City St Zip PECONIC NY 11958-0000 Property Address 1 1635 SMITH ROAD Property Address 2 City St Zip PECONIC NY 11935-0000 Owner Telephone No. 516-734-5210 Tax Map No. section 98.00 block 4 lot 17.000 Cross Street INDIAN NECK LANE Date Of Last Pump Out 2/00/88 Issue Date: 10/26/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK cvFFQ(,r �� Town of Southold � CQ • Application No. Judith T. Terry, Town Clerk • Town Hall, 53095 Main Road ~ _ .•C I $10.00 - Residential a� P. O. Box 1179 u' i��� $25.00 - Non-Residential Southold, New York 11971 O '® 4 'rO*�` Telephone P (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /® � • DATE % 3/9).— OWNER NAME: 81i&4iM l///41A7v OWNER MAILING ADDRESS: /436 &Lei O<3 c'G. fJ 1 OWNER PROPERTY ADDRESS: fektizej OWNER TELEPHONE NUMBER: (cit) 7344-672-1 TAX MAP NO. : Section CO Block '- Lot B 7 CROSS STREET: 9sr(Tic A Ipropri n(miz 966 bm-,t) A.JoacLSP TYPE OF SYSTEM: Septic Tank New Existing V Cesspool New Existing Residential V Non-Residential DATE OF PREVIOUS PUMP OUT: 24g (41- LOCATION / _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.) ?id/Y.-1 -4a1 Signati. e of Applicant RECEIVED BY: e Town Clerk's Office DATE: cer = PV T90 37'x"• A 1 c. 1 1i i '`,. ,0 store •r ,4 g. I . er O r I hi 11 0 39' 0" - t„is .. 3s't "_ __ \i 'O) Sari� i i.Sk� Q ,... 1_ " �' y � k. 141/44 14J `, ID C,..1 /SGe Barbara J. Dittman cJ 1635 Smith Road5 Peconic, NY 11958 �}he� •/ Ct. ri----1 7 I \ .1 DoT 34- ''``. �_ (O 6 \--.,-� AAhr�Ac� // JDf /!Zo of s�p ,. b; i k' -v. at 20 y / b of t0 N o i t//X/ -. - i /_ /;>„„21-.. -- 1.4 -'‘ Zls0 �� .� ! ......: ,. / 9 i , et e,--Tr, IJ _ a 11 .S c ur/a z a/._-.1 d/ ,-n©r zeir 7ai1i-