HomeMy WebLinkAboutPilles Holding Corp (3) SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4334-N Residential Non-Residential X
Fee $ 25.00 New X Existing
Name Of Owner PILLES HOLDING CORP
Mailing Address 1 P 0 BOX 1309
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 56275 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-3168
Tax Map No. section 63.00 block 3 lot 12.000
Cross Street COTTAGE PLACE
Issue Date: 4/25/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ,I 4, y ; Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Vi:** eft. �' Southold, New York 11971
MARRIAGE OFFICER : G 1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =y4 �i��� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER 1 ***0.0 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 i/ Application No.
Permit No. /3-3.V.
Owner Name P( (GS1-4Q lit Coc
Owner MailingAddress •�� ab-x.
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Sam-t-k(16 [ 4, I a°1/
Owner Property Address 5-6,2 7-6' /70.Z g Rd
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Owner Telephone No. 7 '5-- . 16'7
Tax Map No: SectionC++ .Dc) Block . Lot 1 TY Q, a .
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Cross Street llel e.
Please check each that applies: New Construction 7
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 s it copy of survey with SCHD approval.)
Signature-p. ant Date
Received by:
1.:
,
.SCDHS Ref # CIO-06-0006
N
SURVEY OF PROPERTY
AT SOUTHOLD
\i / TOWN OF SOUTHOLD
, r\ SUFFOLK COUNTY, NY
1000-63-03-12
1 SCALE 1'=20'
i NOV 14, 2002 ,
STORAGE BLDGS
c Jon. 24, 2007 (final)
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ANY ALTERA71ON OR ADD/71ON TO THIS SURVEY IS A VIOLATION 'ECONIC S 'F'l OR'' '= ?I. c
OF SEC770N 71090E THE NEW YORK STATE EDUCATION LAW. (631) 765-5 '' 7 797
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EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CER77FICA77ONS P.O. BOX 909 't' \'' „ar•
HEREON ARE VALID FOR THIS MAP AND COPIES 7HERE0F ONLY IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR ,,,1230 TRAVELER ', -i A
WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y. 119 '' —324
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