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Home My WebLink AboutSimon (3) 1. fi// •'�-- ifil ofFatir JUDITH T.TERRY �1 " ' '- Town Hall,53095 Main Road TOWN CLERK Fn; s M 4 P.O.Box 1179 1,� Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 6 nv 1 Fax(516)765-1823 RECORDS MANAGEMENT OFFICER MARRIAGE OFFICER _ • 11 In" ��, X11 Telephone(516)765-1800 `is' � � 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. 3346-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner SIMON, ROBERT K. Mailing Address 1 379 WOOD LANE Mailing Address 2 City St Zip PECONIC NY 11958-0000 Property Address 1 379 WOOD LANE Property Address 2 City St Zip PECONIC NY 11958-0000 Owner Telephone No. 516-734-4211 Tax Map No. section 86.00 block 6 lot 3.001 Cross Street INDIAN NECK LANE Issue Date: 6/12/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) eve OFFICE OF THE T0WN CLERK 0 � ,it6 Town of Southold S\FF�(�'4, •� ;•:� Application N- Judith T. Terry, Town "Clerk' % '0 ' �,...t .•C $10.00 - Residential Town Hall, 53095 plain Road �H,�, . t; ' P. O. Box 1179 cry a,r t�,. $25.00 - Non-Residential Southold, New York 11971 1.W*41b #....°��` Telephone 01 14 �� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • • DATE 6/ //?S- . OWNER NAME: 'Rp6F/r-T i SIM OA) • • OWNER MAILING ADDRESS: 3 7q Gc)©o>> 4.A-Ai P&-_-ccAi/ c... OWNER PROPERTY ADDRESS: s iY7e-- OWNER TELEPHONE NUMBER: 7:31. ^ 44R // a TAX MAP NO. : Section 006 Block C.40 Lot 3 , i CROSS STREET: --nu p i /UFcie. /f!-n/E TYPE OF SYSTEM: Septic Tank New Existing Cesspool ✓ New ✓ Existing Residential 1./ Non-Residential DATE OF PREVIOUS PUMP-OUT: ,/®A/zc 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.) 6, ,d/(4-\---/>.2/- Signature of Applicant RECEIVED BY: i Town Ierk's Office DATE: Cp ' I ' 1 . . • • i I • !\ X20 _ `` ( ' ,l AJI ' _ 'i j yi I' --.-`Y� _.... L.,..') ...___.,.....__. t,---- OT -----, H-Nt t� is ,l.r,•' .. I:..e,.-r,:,•, ,, ...•,.r-,-�':� '` - a r ✓ - C.; ,r 1.._./ ER - -1/4,—) e� 1 }Z"-.r,,,PJp;� K �'.t. ;.�*'". �,- f�•��, - , •` '` t•; - _ �' Eca-!i C , ' " • r ,rQny',�i--...q It -r=a ,,- ;-- ,-/..( ., ;/ - • j •� t��y,(j �''}��.--.....- .._--...�.'^`.-�..--.�.- ( F; '� , . . ,/...,0„,,i'O✓ ,..A-0,-, _ - - 1•,'•if'. -�4':. ! ' " -'r•-` �f - I - • -,i ti YV t�i Oj"`�' ��:! ;,7(.�l,,Jr 3 V. T, ' - _ • +- :t.�,r'- •�l =ir,. - •fir Y✓ i • - - �i ' _ r F ,,W.:''°' �`t,••-'•;.: .rt y -1: ..f" , , EPTiG' r$5 TH , - - — , ' - si 5,74 e,., -L r. -1 ., t �/ 45:i I�, ►'� ;- = �',', *fit;' L` f f 'W!•• -, - - _ ` .; ', <F• ' _ -/-4- Yi .t- '` '�'rV,`_ - _ - _ • y \\tel ) sol`�- _ J� t.i " J�'- 3i� r, ,w.�� `-"y /� - • ....-" - _ 7�` - - • : 0- 1--.:-.- , f :_- -1..'-'?. ' i . .. o .'-,q ,-j i et /-;' - .I.. p -..,.a-,.*:rrv. -fel:� • ; , -4.1-• m 3 ,f colo ' : - - ! - ' - - i' i i: ' \ l' -'- ,. . (� t i '--•-•--S 4, 1 O i I '. - =, - '/ - ' '. _ - / .��i 1� j �: /° L - -- • L-.-e--- t,:-/1 i eis j dry 4Ljr} t �I t .t.' �- - - _ _ • _ _- - ` - 1 jar' f i tr.': . J .1• J -k ti ✓4! i ,(t i0.0 1 moi- 7----------:-- r 1 J /II S 1( ' J .21.I` r t 4.li ; Lt ,.�6• / ; ' / t .,� i C3:M t: :At4i �' 6' . t' -A. .t DE.E7,..•NOV.