HomeMy WebLinkAboutMCM Main Road LLC SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4324-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MCM MAIN ROAD LLC.
Mailing Address 1 P 0 BOX 762
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 11250 MAIN ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 631-298-5448
Tax Map No. section 122.00 block 3 lot 800
Cross Street JOHN STREET
Issue Date: 10/26/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
,I�,O�giIFFO�,�co •
ELIZABETH A.NEVILLE ���0 Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS coSouthold,New York 11971
MARRIAGE OFFICER \ G '� 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER P Orisi� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ' * *aa ' southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 I or Non-Residential @ $25 Application Noy3,a
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Permit No.
Owner Name /14 L (P1 t144-id g0 fl' L L C
Owner Mailing Address p. 0 . 63,s 7-6
. /14s-2--
Owner Property Address k V 1 C O Pn 1D ROAN
/_/sl fY tack/ N3 , 119 5'g--
Owner Telephone No. t 31 — 2-9 8 - 5 '
Tax Map No: Section 1 2 2 Block 3 Lot 8
Cross Street . hn ,5-1-reef
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.)
110106
Signature of Applicant Date
Received by:
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,-.1 ,.r MATTHEW & LAURIE DALY
11250 MAIN ROAD
MATTTTUCK
122-3--8
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