HomeMy WebLinkAboutPorky's Rest sioc_IFour -
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,� Town Hall, 53095 Main Road
® . P.O. Box 1179
'��Q( DIA 'P ,"/ Southold, New York 11971
JUDITH T. TERRY -,,,,.1,04°°° TELEPHONE
TOWN CLERK (516)765-1801
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. 86-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner PORKY'S RESTAURANT, INC.
Mailing Address 1 BOX 100
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 NORTH ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1338
Tax Map No. section 35.00 block 1 lot 21 .000
Cross Street SOUND ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 4/07/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
,..l OFFICE OF THE TOWN CLERK
Town of Southold &,N) - CQ ' , Application No.'
Judith T. Terry, Town Clerk . 41z-2 i", ,. i4
Town Hall, 53095 Main Road ` . :< Residential /
p. O. Box 1179 to "_ °' i '�' Non-Residential //
Southold, New York 11971e�`�
Telephone _/0.( y►
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or. CESSPOOL
Operation Permit No. -(,o
Fee $
DATE t/- 0
OWNER NAME: 4X/is' 457-1104,9-er //1/
OWNER MAILING ADDRESS: /mer'/- /de
6/26-4/447---- ,i/ i/qty
OWNER PROPERTY ADDRESS: /'„,7? - (f
66&6gV/0L7— 4/7 i,'q'yci
OWNER TELEPHONE NUMBER: & 977---133 '
TAX MAP NO. : Section Block j Lot 02/
CROSS STREET: 0un1 p �/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing 1/
Residential Non-Residential 17
DATE OF PREVIOUS PUMP-OUT: -0-19-4/
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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61l�21e�Si�na`tur
g ofApplicant
RECEIVED BY:
Town Clerk's Office
DATE:
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