HomeMy WebLinkAboutLove Lane Corporation I, I',
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ,1 T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS tl'i Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
1°. Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 135-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner LOVE LANE CORPORATION
Mailing Address 1 32 EAST MAIN STREET
Mailing Address 2
City St Zip RIVERHEAD NY 11901-0000
Property Address 1 195 LOVE LANE
Property Address 2 (BARKERS PHARMACY INC. )
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-727-2125
Tax Map No. section 141 .00 block 4 lot 29.000
Cross Street PIKE STREET
Date Of Last Pump Out 0/00/00
Issue Date: 12/10/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •COFOUr - r)
Town of Southold � CQG Application No. l
Judith T. Terry, Town Clerk $10.00 - Residential
Town Hall, 53095 Main Road
P. O. Box 1179 u' tri � $25.00 - Non-Residential
Southold, New York 11971 O `
Telephone '0 \•
(516)
(516) 7 65-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ �,.. —
DATE 12 - - cL
OWNER NAME: Lc31JP LAN r CUR 4rZ�"tFa��/
OWNER MAILING ADDRESS: ,3 C/� � ��J� ;ry S1Ll`z�c
N. // 20 /
OWNER PROPERTY ADDRESS: 1 ' ' �Uie , /e•'
'A- -f:f,) c.k,_� j\!- C(. 1 ? s L
OWNER TELEPHONE NUMBER: c7 _ 71-7 - Z al--
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TAX MAP NO. : Section / L( / Block ( Lot 2- 9
CROSS STREET: SAP-- 1( I / j ?/. riv /or i .
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
as2_ ‹"A
Signa re of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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