HomeMy WebLinkAboutHarborview Homes Inc (2) �� ,ZO OG
ELIZABETH A. NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERKy �'� P.O. Box 1179
v, Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS 4 $
MARRIAGE OFFICER :4. �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER = �Ol *,„•0 Telephone (631) 765 1800
FREEDOM OF INFORMATION OFFICER 1 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4135-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner HARBORV I EW HOMES, INC.
Mailing Address 1 1706 COUNTY RD 39, SUITE 2
Mailing Address 2
City St Zip SOUTHAMPTON NY 11968-0000
Property Address 1 120 RHODA ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 631-287-0772
Tax Map No. section 106.00 block 5 lot 20.000
Cross Street RUTH ROAD
Issue Date: 3/21/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK " ,.
TOWN OF SOUTHOLD 0F Application No.
ELIZABETH A.NEVILLE,TOWN CLERK 10.00 - Residential
�.�" 1 ��±J�
�'
P.O.BOX 1179 $
SOUTHOLD,NEW YORK 11971 $25.00- Non-Residential
Telephone 149 3114 ` ' ';
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 3A-4 ?—
OWNER NAME: {kr bdrVIP�
OWNER MAILING ADDRESS: /7d ( Co l`e., 3 s c5e-4-4-rt z
S fri.42 a �( // LP
OWNER PROPERTY ADDRESS: e -�,,r",L
/14)0 RA0G4-' nd rnAr7-
OWNER TELEPHONE NUMBER: ( L3) 2 `({) .-O 2-
TAX
TAX MAP NO. : Section /4r4 Block Lot 2�0
CROSS STREET: Q (2A
TYPE OF SYSTEM: Septic Tank New k Existing
Cesspool New , Existing
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.)
1A11/044
,
Signa- 6.1) pp icant
RECEIVED BY: .
Town Clerk's Office
DATE: Ila'1. 10;—