HomeMy WebLinkAboutL&R Vineyards • '�/�
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JUDITH T.TERRY �� _ : Town Hall, 53095 Main Road
TOWN CLERK ti Z P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS `wO �4,� Fax(516) 765-1823
�� Southold,New York 11971
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER : 491 * 4;00 Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 164-N Residential Non-Residential X
Fee $ 25.00 New Existing X
Name Of Owner L & R VINEYARDS
Mailing Address 1 C/O JAY ANDERSON
Mailing Address 2 370 7TH AVENUE
City St Zip NEW YORK NY 00000-0000
Property Address 1 3790 OREGON ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 212-594-7915
Tax Map No. section 101 .00 block 1 lot 5.002
Cross Street MIDDLE ROAD
Issue Date: 11/15/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 0cvFF�(ire �i /,C/
Town of Southold , c 3 .' ' , Application Q�(�
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 8 ,fir ,, -4 I $10.00 - Residential
cry _:' tri ` $25.00 - Non-Residential
P. O. Box 1179 �1:. � ' ' $
Southold, New York 11971 4--/0/ :,�'� ��°''
Telephone of
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(516) 765-1801 ,,
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ,aI
DATE N ojcyip
OWNER NAME: / ' de 147a0 Ch
1' � 7
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OWNER MAILING ADDRESS: /o JAY /Onip!/l Soh
17'3 7 Ave ,tk C N/
OWNER PROPERTY ADDRESS: 3790 O, . o ,v- 1ce.
Cc/%c '- /cy [mac:l 44V //'_3,( V —
OWNER TELEPHONE NUMBER: Z)2- _ f -7 9 /3
TAX MAP NO. : Section /0 / Block 7 Lot S 2
CROSS STREET: 622c::-3a/-) eo /A1,'bboL6_--s2j2 .
TYPE OF SYSTEM: -Septic Tank_ - . New Existing ✓ /%
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Cesspool New Existing
Residential Non-Residential 1/
( 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.) )
a2/t" it/'"" —_______
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4 Signature of Applicant
RECEIVED BY: -
' - - Town Clerk's Office
DATE:
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