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HomeMy WebLinkAboutColonial Village 1.1 pill 111 :' xy '®-.4 Town Hall, 53095 Main Road i ;'', =`_ P.O. Box 1179 ®r/'� Southold, New York 11971 ' ` �s2 �1�` TELEPHONE JUDITH T.TERRY I 11_: (516) 765-1801 TOWN CLERK REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 75-N Residential Non-Residential X Fee $ 25.00 Septic Cesspool X New Existing X Name Of Owner COLONIAL VILLAGE Mailing Address 1 BOX 1015 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 52965 MAIN ROAD Property Address 2 UNITS 16 THROUGH 20 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-3436 Tax Map No. section 63.00 block 3 lot 27.002 Cross Street BOISSEAU AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 11/01/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) 1 , A OFFICE OF THE TOWN CLERK C3\\V Town of Southold Application No.1/47 Judith T. Terry, Town Clerk Town Hall, 53095 Main Road ,. } Residential P. O. Box 1179 to w'x *03^'" f `' Non-Residential • Southold, New York 11971 Telephone -0 (516) 765-1801 _ 1 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. /v R Fee $ cQ.5 02) DATE October 24, 1988 OWNER NAME: Colonial Village OWNER MAILING ADDRESS: Box 1015 Southold, N.Y. 11971 OWNER PROPERTY ADDRESS:52965 Main Road Southold, N.Y. 11971 OWNER TELEPHONE NUMBER: 765-3436 TAX MAP NO. : Section 43P Block 3 Lot ,S7-22 CROSS STREET: Boisseau Avenue TYPE OF SYSTEM: Septic Tank New Existing X1 - Cesspool - New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: Uri'; r� icein 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.) 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