HomeMy WebLinkAboutMain St Supermarket OFFICE OF THE TOWN CLERK
Town of Southold , c��FF�(/�`+O(j
Judith T. Terry, Town Clerk y�
Town Hall, 53095 Main Road , •
P. 0. Box 1179
Southold, New York 11971A �4 •-
Telephone Ol 4t 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
• OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR32 Residential
Fee $
25.00 Non-Residential X
Septic Cesspool X
NAME OF OWNER: Main Street S.upermarket, Inc.
OWNER MAILING ADDRESS: Main Street
Southold, New York 11971
OWNER PROPERTY ADDRESS: Main Street
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-3040
TAX MAP NO. : Section 61 Block 4 Lot 25.1
CROSS STREET: Youngs Avenue
TYPE OF SYSTEM: Septic Tank New Existing,
Cesspool X New Existing X
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terry
Southold Town Clerk
DATE: January 7, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c3IFO(A-l' /�/
Town of Southold ��� QG' . Application No. 3
Judith T. Terry, Town Clerk *%_ 1'1
- Town Hall, 53095 Main Road ~ Residential
P. O. Box 1179 ® t Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
' for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ c�,
DATE / ; - - ' — O
OWNER NAME: 1. \j/f ' , ; ,
OWNER MAILING ADDRESS:'
OWNER PROPERTY ADDRESS: a-7,--72 -
OWNER TELEPHONE NUMBER: 7o6"---c,,,56:3
TAX MAP NO. : Section 6 1 Block 9- Lot c c )
CROSS STREET:
( a
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: .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.)
A
•
Signat -re of • pplicant
RECEIVED BY: • `%J�%( ���
o '� ,.rk's Office
DATE: /0/0/Z--
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