HomeMy WebLinkAboutManzi Homes Inc (28) - •
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ELIZABETH A.NEVILLE ���' � OCG Town Hall, 53095 Main Road
TOWN CLERK ; * * P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ezi
Q i Southold,New York 11971
MARRIAGE OFFICER �O��� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER \ l �•� Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER `'�C�U +����� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4302-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MANZI HOMES INC
Mailing Address 1 PO BOX 702
Mailing Address 2
City St Zip ROCKY POINT NY 11778-0000
Property Address 1 11255 SOUND AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 631-744-1039
Tax Map No. section 141.00 block 3 lot 6.003
Cross Street OLD NECK ROAD
Issue Date: 12/20/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A. NEVILLE tie4`Z� �V%, Town Hall, 53095 Main Road
111° TOWN CLERK p P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � yy, Southold, New York 11971
MARRIAGE'OFFICER• Q 'F 1� .• Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER \y4 a0. / 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 @ $10or Non-Residential @ $25 Application No.
Permit No.
Owner Name f'k G/1Z i TTp'- e r t ►'1 C
Owner Mailing Address R- 0 aQ.\-. -70Q.
(LOC-4 Po;�� Nli )1 ? ? A
Owner Property Address I( a 5- ,S" rrs-- OLj3 A cJ'�
c-t l 4 t4.C cl
Owner Telephone No. (31 - 7 t/(1- 10 3 /
Tax Map No: Section III I Block Lot 6. 3
Cross Street 01.h lU ec k Q.A
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.)
. _ �1P h2h low
gnature of Ap p cant Date
Received 'M181 ..i94.0-a