HomeMy WebLinkAboutWitzke . �' II_/iii••
®if gVFFOuree
JUDITH T.TERRY �� � y� Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
rnrSouthold,New York 11971
REGISTRAR OF VITAL STATISTICS ® 1
MARRIAGE OFFICER #.111
� 11 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER = ®.( * ���d� Fax
(516) 765-1800
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. 3426-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner WITZKE, RICHARD AND DENISE
Mailing Address 1 1150 JASMINE LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1150 JASMINE LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1349 0!3
Tax Map No. section 69.00 block 3 lot —23013
Cross Street APPLE COURT
Issue Date: 1/19/96 Judith T. Terry
Southold Town Clerk
(TOWN 'SEAL)
I
4 s
OFFICE OF THE TOWN CLERK %\\ FOC,-��-
3C-P4
Town of Southold CSG Application No.,
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road .7-4 $10.00 - Residential
P. O. Box 1179 cry ° :' $25.00 - Non-Residential
Southold, New York 11971
Telephone p.(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION RECEIVED
for JAN. 1 81996---
O P E R AT I O N PERMIT Town Clerk Southold
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE L 9 J /8, /29
OWNER NAME: fc,ie//a/q ''
OWNER MAILING ADDRESS: /A-00-7.41_5-/-72//:/;:g
_5224174-A.d4-/ , "/e0a1 X/74e/ 1/97/
OWNER PROPERTY ADDRESS: ,5-2&.3-?F p,,,,- A4—eve -
OWNER TELEPHONE NUMBER: .._.516)7,4d--7-/j /9
TAX MAP NO. : Section/pc/0 -06p Block 03 Lot c2//,l•
CROSS STREET: /4//,0/0/e Cou/17—
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool �( New Existing x
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.)
/'7, -1r, a-7/---7e9.,
Signature of Ap ' nt
RECEIVED BY: �-"-p
To n Clerk' Office
DATE: ( ' ( � ` �
4
1
CeO'%� - i
\ ,s, ISP,,,,`?e '/\ ' .
•
il
�e so: by
/ . .'
OT / .--,,® 7 •
,,
et., it\
/01%
�4)
? V 0)
• OT .
_;
o ?s 3h
/.........1„.:Ni. 2'� . •nc� f?se. y ?e,o'er e
'V / s1, 3 ' 20,E cy
' "y /• ?�.3 AREA - 15,630sgf
/ 1 4 '&- ' / �� _
iP47 l�Jc n
/ ho
11 't
•`y •
qi
‘.,;04P O _3
Gy
ti 0
!4,/ . ;:s
�` 3SS 83• �.�N Q�/ •"
c1 ` L J 09,7.
�`
Rcq
j
,.
..„4/2....,,, v, , L44
, :,
The locations of wells and cesspools
shown hereon are from field observations ELEVA TIONS ARE REFERENCED y.
and or from data obtained from others. TO AN ASSUMED DATUM. KDEf.'