HomeMy WebLinkAboutHellenic Snack Bar OFFICE OF THE TOWN CLERK • 'OF OL/'`D
Town of Southold DSO
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road i�
P. 0. Box 1179 V n -;
Southold, New York 11971 ` Q ® ,
Telephone 100/4/%"*,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT _
SEPTIC TANK or CESSPOOL
Operation Permit No. NR49 Residential
Fee -$ 25.00 - Non-Residential X
Septic Cesspool X
- NAME OF OWNER: Hellenic Snack Bar
OWNER MAILING ADDRESS: Main Road, Box 506
East Marion, New York 11939
OWNER PROPERTY ADDRESS: Main Road
East Marion, New York
OWNER TELEPHONE NUMBER: 516-477-0138
TAX MAP NO. : Section 35 Block 2 Lot 14
CROSS STREET: Shipyard Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X= New Existing X
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: March 1987
`s: I.,r�Ijth T Torr
Southold Town Clerk
DATE: August 25, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK CO HU(
Town of Southold ��® Application No.
Judith T. Terry, Town Clerk ars
-t
Town Hall, 53095 Main Road Residential
P. O. Box 1179 cn "'` :' Non-Residential
Southold, New York 11971
Telephone oI iNt
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. M%
Fee $ 9,3®
DATE 7r57
OWNER NAME: lisba,V7Cc 54, i,(d 42IZ
OWNER MAILING ADDRESS`:-- e47/0 /,pj) , ®, etYy s-t9-4
4,51(37- /1 ero-d etLX 037
j
OWNER PROPERTY ADDRESS: e../ ei
OWNER TELEPHONE NUMBER: 7✓ of ,3k'
TAX MAP NO. : Section 3S Block Lot f
CROSS STREET: / w D 149-Vie
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential ' lor
DATE OF PREVIOUS PUMP-OUT: 3/r„?
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.)
firs
Signature o ' p!cant
RECEIVED BY: C
Ell 'own erk's fice
DATE: AUG 2 5 1987
Town Clerk Southold
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