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Home My WebLink AboutDomino, Michael �o• •ie," SO(/ryo l 4 ELIZABETH A.NEVILLE +P ' Town Hall,53095 Main Road TOWN CLERK 4 P.O. Box 1179 H ar Southold,New York 11971 REGISTRAR OF VITAL STATISTICS G Q �s MARRIAGE OFFICER ; :?` . ,I Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER l �••1 Telephone(631) 765-1800 ,rN FREEDOM OF INFORMATION OFFICER COUN ,,,.� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4300-N Residential Non-Residential X Fee $ 25.00 New X Existing Name Of Owner DOMINO, MICHAEL Mailing Address 1 PO BOX 75 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 74365 MAIN ROAD Property Address 2 City St Zip GREENPORT NY 11944-0000 Owner Telephone No. 631-765-9402 Tax Map No. section 45.00 block 4 lot 3.001 Cross Street MOORES LANE Issue Date: 12/20/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) it.440FF01i� /14' 4+tipa\ ELIZABETH A.NEVILLE Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTICS � I 1 Southold, New York 11971 MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �` I * *sof' Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER ,,,,,, 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 @$2 5 pplication No.Lf3d Permit No. 3 5 2-5 41 Owner Name in/a Q Pj 10-7-02/M4Y— Owner Mailing Address /2 c Owner Property Address 14341-- /,,Qt/!'V/G--( Owner Telephone No. ` ' r"---q Li()l_ Tax Map No: Section ` Block (1 Lot 3_ Cross Street 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.) oe<A4A- 3 // Signa e o Applicant Date Received by: �o� p�0�SO!/l�ol ELIZABETH A.NEVILLE tiQ . Town Hall, 53095 Main Road TOWN CLERK 4, 4115; P.O. Box 1179 REGISTRAR OF VITAL STATISTICS N ac Southold, New York 11971 MARRIAGE OFFICER �: Fax.4;1 Fax Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER (C0 , *0.0 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3323 N Residential Non-Residential X Fee $ 25.00 Septic X Cesspool PERMIT ISSUED TO: Name : GREENPORT HEIGHTS DEVELOPMENT Address 1: PO BOX 75 City St Zip GREENPORT NY 11944 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #C10-03-0014 Name Of Owner GREENPORT HEIGHTS DEVELOPMENT Mailing Address 1 PO BOX 75 City St Zip GREENPORT NY 11944 Property Address 1 3590 OLD NORTH ROAD City St Zip SOUTHOLD NY 11971 Tax Map No. section 45.00 block 4 lot 3.001 Cross Street MORRES LANE Building Permit Number Cross Reference: • / qvia Issue Date: 7/08/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL)