HomeMy WebLinkAboutCarbone, Michael ,OF S0074,"
ELIZABETH A. NEVILLE � 'l4O4 \� Town Hall, 53095 Main Road
TOWN CLERK * * P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G Q ,i Southold, New York 11971
MARRIAGE OFFICER �� �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER O40 � .0' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �UN 1' " southoldtown.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. 4348-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MICHAEL CARBONE
Mailing Address 1 165 EAST 32ND STREET APT11E
Mailing Address 2
City St Zip NEW YORK NY 10016-0000
Property Address 1 1580 NORTH BAYVIEW ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-4900
Tax Map No. section 70.00 block 12 lot 3.400
Cross Street OAKWOOD DRIVE
Issue Date: 7/18/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE It Ovi Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER :yy. Southold, New York 11971
4�1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =y�Q a��i.� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER :.'� * ,1' 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
14
Residential @ $10 or Non-Residential @ $25 Application No."f 5
Permit No. 3Cg�V2--
Owner Name p_1 C•\CL \ Ccs..iL_b rva,
Owner Mailing Address 1 c Ms S c YCk 3*ce C i-- T 11 t'
0e—k—&) (---t or-k y) 3 4O; kf 1 00iLO
Owner Property Address 15 b Q'O( -'\ Ckl._i() ,eL kc
- ,PL... ): A-0 Id K)L 1 C-1 1
Owner Telephone No. : \ 7 Co 5- L-1,/00
Tax Map No: , Section /0 �
_Block I, #).— Lot -
Cross Street v V Drt Lr-{
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.)
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(;, i a ature of Appli. _, t Date
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Received by:
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SURVEY OF PROPERTY
AT SOUTHOLD':
47,40).� Al* TOWN OF SO�DLD
• ��� SUFFOLK cOUNT .-;:N Y.
?:,r .i - i?o, 4, 1000-70-12-34
` 11, 2004 ,
' *0 SEP. 9, 2004 (revision)
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SUFFOLIf COUNTY DEPARTMENT
40j, APPROVAZ.OF t'OF HEAL.
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•2a02, W (631) 765-5020 FAX (631) 765-1797
1230 P.O. BOX 909 .
SOUTHOLO VEL,
S. Y. 71 T O'¢_236
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