HomeMy WebLinkAboutSouthland Corp OFFICE OF THE TOWN CLERK HU(
Town of Southold ����� �CO�
Judith T. Terry, Town Clerk Z
Town Hall, 53095 Main Road -
P. O. Box'1179 �
Southold, New York 11971 Q O�-,4!
Telephone ( t Nt
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR 19 " Residential
Non-Residential X
Fee $ 25.00
Septic Cesspool
NAME OF OWNER: Southland Corporation
OWNER MAILING ADDRESS: 450 Waverly Avenue
Patchogue, New York 11772
OWNER PROPERTY ADDRESS: Main Road
Greenport, New York
OWNER TELEPHONE NUMBER: 516-654-3700
TAX MAP NO. : Section 46 Block 1 Lot 2,7
- CROSS STREET: Ninth Street
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: September 1986
Judith T. Terry
Southold Town Clerk
DATE: C October_22, 1986
(TOWN SEAL)
/I IIS _
OFFICE OF THE TOWN CLERK r.31F ( ri.,- _
Town of Southold \)) r- CQG'_ Application No. %/e 0
Judith T. Terry, Town Clerk . ,; t4:\
Town Hall, 53095 Main Road c :< Residential
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P. O. Box 1179 STM. �',�.` Non-Residential c�
Southold, New York 11971 '
Telephone Qly ltvo
(516) 765-1801
TOWN OF SOUTHOLD
Ntl:/ QED SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OCT 2251
6)
APPLICATION
iCtrrlc Sh
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 25 ,00
DATE
OWNER NAME: Southland Corporation
OWNER MAILING ADDRESS: 450 Waverly Ave
Patchogue N.Y. 11772
OWNER PROPERTY ADDRESS: main Rd nx 9.t St; eet
Greenport , N.Y. 11944
OWNER TELEPHONE NUMBER: 516 654 3700
TAX MAP NO. : Section Block Lot 02, 02
CROSS STREET: 91'1,
TYPE OF SYSTEM: Septic Tank e. New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: Ci/?(P
LOCATION MAP: Must be attached hereto before permit may be issued. 1111
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Signature of • pplicant
RECEIVED BY: ifig(----y_6t6,_ ,
TownClerk's /Office
DATE: �.L. /9/4
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