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HomeMy WebLinkAboutMatine Inc /�0 '%)FFOL11 00 ELIZABETH A.NEVILLE �`� y�` Town Hall, 53095 Main Road TOWN CLERK t H Z ; P.O. Box 1179 Pry REGISTRAR OF VITAL STATISTICS Vat 1� Southold, New York 11971 MARRIAGE OFFICER ;yifJ ��• Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER --7R1 * $,ip•, Telephone (631) 765-1800 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. 4270-R Residential x Non-Residential Fee $ 10.00 New x Existing Name Of Owner MATINE INC mailing Address 1 PO BOX 1925 mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 590 NORTH VIEW DRIVE Property Address 2 City St Zip ORIENT NY 11957-0000 Owner Telephone No. 631-765-6220 Tax Map No. section 13.00 block 1 lot 5.001 Cross Street BROWN'S HILL ROAD Issue Date: 1/18/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) r A OFFOLie ELIZABETH A.NEVILLE ' Town Hall,53095 Main Road S TOWN CLERK 3 P.O.Box 1179 REGISTRAR OF VITAL STATISTICS ; v, outhold, New York 11971 MARRIAGE OFFICER 1 O (:". '� �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �G1, Ar Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER . * ,s'° southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 / or Non-Residential @$25 Application No.ga7O Permit No. Owner Name M A 1/A(1 /Al C Owner Mailing Address P- c . 40y / 7 .75- V. .7sXi. %. 119 7/ Owner Property Address $ ?O A/0 n l�-E 2/ Citi✓ R . C>/21 (-- 7 N y0x,( Owner Telephone No. 7C5 6 0 Tax Map No: Section / Block / Lot -S Cross Street /n 0 wa.'S `/i c c. l2 p Please check each that applies: New Construction Alteration to Existing System Residential Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) i --Sfgnature of Applicant Date Received by: Town Of Southold • P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 11/19/04 Receipt#: 1590 Transaction(s): Subtotal 1 Septic Permit-Operation - Resid. $10.00 Check#: 1590 Total Paid: $10.00 Name: Ma, Tine Inc P.o. Box 1925 Southold, NY 11971 Clerk ID: LYNDAB Internal ID: 101831