HomeMy WebLinkAboutJKNK, LLC (3) %pSO�Iy-
ELIZABETH A. NEVILLE I '`c l0 : Town Hall, 53095 Main Road
TOWN CLERK A P.O. Box 1179
CO Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1
MARRIAGE OFFICER � ��% , Fax (631) 765-6145
RECORDS MANAGEMENT OFFICEROI �� Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER - OUN11 isossoutholdtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4318-N Residential Non-Residential X
Fee $ 25.00 New X Existing
Name Of Owner JKNK, LLC
Mailing Address 1 PO BOX 33
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 13650 MAIN ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 631-298-0005
Tax Map No. section 114.00 block 11 lot 24.003
Cross Street WICKHAM AVENUE
Issue Date: 8/03/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE y� ; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O �t Southold, New York 11971
MARRIAGE OFFICER \.1 ��,1° Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER 1 �a�i�� 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 @ $25 X Application No. 3 4 2 9R
Permit No. 143 1 K
Owner Name JKNK, LLC
Owner Mailing Address P.O. Box 33
Mattituck, New York 11952
Owner Property Address 13650 Main Road, Mattituck, N.Y. 11952
Owner Telephone No. 631-298-0005
Tax Map No: 1000 Section 114 Block 11 Lot 24.3
Cross Street Wickham Ave . (nearest streets) Reeve Avenue
Please check each that applies: New Construction •
Alteration to Existing System Overflow cesspool to existing
Residential Non-Residential X cesspool system
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 su ey with SCHD approval.)
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July 20, 2006
:ignature .f pp icant Date
• y . Kardwell
Received by:
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