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ELIZABETH A. NEVILLE �� h 0 %:
Town Hall, 53095 Main Road
TOWN CLERK % O % P.O. Box 1179
H Southold New York 11971
REGISTRAR,OF VITAL STATISTICS '
MARRIAGE OFFICER `` y �����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER L �Q $ 0i0 Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER ���� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4185-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MUNIZ, CARLOS M.
Mailing Address 1 P 0 BOX 411
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 1080 PARKVIEW LN
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 631-477-3308
Tax Map No. section 15.00 block 5 lot 24.021
Cross Street RYDER FARM LANE
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Issue Date: 1/28/03 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK SlMet,"
TOWN OFSOUTHOLD �, OG Application No. �/63
)7LIZABETHA.NEVILLE,TOWNCLERK $10.00 - Residential pc
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 ��� $25.00 - Non-Residential
Telephone _0j 4( 0,to
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE / '/. a 3
OWNER NAME: 6'10� A /(LA;;; z
OWNER MAILING ADDRESS: P. e2. Z5&x Wil/
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OWNER PROPERTY ADDRESS: /D8a )0arkvi'e� Lo.
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OWNER TELEPHONE NUMBER: (3/ . 1/77. 3308
TAX MAP NO. : Section /5. )O Block 5- Lot .247. dZ /
CROSS STREET: /yfir- LaNe-
TYPE OF SYSTEM: Septic Tank New L/ 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.)
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Sig '.''i 1!•licant
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RECEIVED BY: /—
Town/Clerk's Office
DATE: //),-
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ARTCO DRAINAGE CORP.
P.O. BOX 1132 MATTITUCK, NEW YORK 11952
(631) 298-9660 • FAX (631) 298-2291
Certificate of sewage dispose system by installer
Health Dept Reference number R10-
Suffolk tax map#: Dist: 1000 Sect(s) 15 Blk(s) 05 Lot(s) 24.21
Project name or Address: 1080 Parkview Lane,Orient
Subdivision Name&Lot# Orient by the Sea
Applicant's Name Carlos Muniz
Description of system installed:
Septic Tank
Volume(gallons) 1000
Shape rectangle
Name of Precast manufacturer: Coastal Pipeline
Leaching Pools
Number of pools -2
Diameter and depth—8' x 6'
Name of Precast manufacturer: Coastal Pipeline
Other
Attach or sketch below the measurements from building corners to the access covers of disposal
system.
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I hereby certify that the subsurface sewage disposal system, described herein,has been installed
by me in accordance with the plans and standards of the Suffolk County Department of Heath
Services: and is operational.
Installer
Signature Date /7/3 O d.-
Artco Drainage Corp 631-298-9660
Consumer Affairs License Number 206W