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JUDITH T. TERRY �� r , Town Hall, 53095 Main Road
TOWN CLERK � Box 1179
REGISTRAR OF VITAL STATISTICS F s �� P.O.Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
4S.G,off` Telephone (516) 765-1801
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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. 1836-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MANDEL FAMILY CORP.
Mailing Address 1 P. O. BOX 2130
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 1100 YOUNGS AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-477-2223
Tax Map No. section 60.00 block 2 lot 7.001
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 1/22/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK S\FFO(,r�'-
Town of Southold & . .;" CQG• , Application No. /131
Judith T. Terry, Town Clerk
Town Hall,
53095 Main Road . $10.00 - Residential
P. O. Box 1179tri kzi��`' $25.00 - Non-Residential
Southold, New York 11971 O .cs.# ' �l �`
Telephone *Of \c,"
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
' for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /fcc-6
Fee $
DATE Januatty 16, 1992
OWNER NAME: Mandel Family Corp.
OWNER MAILING ADDRESS: 443 Man St)r.eet, P. 0. Box 2130
Gree'ipojrt, N.Y. 11944
OWNER PROPERTY ADDRESS: 1160. Young-4' Ave. ' -
Southold, N.Y.
OWNER TELEPHONE NUMBER: 516-477-2223
TAX MAP NO. : Section 60. Block 2 Lot 7.001
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New Existing XX
Residential Xx Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
4-d4j1‘ R%-g4-e-/
Signature of Applicant
RECEIVED BY: .
Town Clerk's Office
DATE:
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PO. BOX 909
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54655 MAIN ROAD
SOUTHOLD, N.Y. //971
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