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8UFF{)[K COUNTY GOVERNMENT
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES, DIVISION OF ENVIRONMENTAL QUALITY
OFFICE OF WASTEWATER MANAGEMENT, 360 YAPHANK AVENUE, SUITE 2C, YAPHANK, NY11080
Today Date: 01/21/2021
Application: C10180810-ZEC
Application Type: Other Than Single Family Residence Application
Address:
Fee Allocation:
Fee Item Description Fee Amount Amount Paid Amount Paid Total Balance Due
Board of Review variance/waiver $000.00 $090.00 $900.00 $0.00
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Tota|: $000.00 $090.00 $000.00 $0.00
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ReoeiptNo. 418447
Payment Method Chaok# Amount Paid Payment Date Payor Comments
Check 35265 $900.00 01/21/2021 pVVGROSSER
CONSULTING,
INC
Contact Info: STRONG'G YACHT CENTER
STRDNG'S YACHT CENTER
5780 WEST MILL KD
K8ATT|TUCK. NY11052