HomeMy WebLinkAboutSCNB y
/'',S�FF04-=
JUDITH T.TERRY 'Town yJ°t `Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
s• �� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER N.4* t"/ Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER ®.l jig I►��10. Telephone(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. 159-N Residential Non-Residential X
Fee $ 25.00 New Existing X
Name Of Owner SUFFOLK COUNTY NATIONAL BANK
Mailing Address 1 5 WEST 2ND STREET
Mailing Address 2
City St Zip RIVERHEAD NY 11901-0000
Property Address 1 10900 MAIN ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-727-2700
Tax Map No. section 143.00 block 3 lot 4.002
•
Cross Street BAY AVENUE
Issue Date: 7/16/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
0.
(OFFICE OF THE TOWN CLERK c,\WFO(,I(.01.
- -
Town of Southold C� •�, Application No.N 159
Judith 'Y. Terry, Town Clerk
Town Hall, 53095 Main Road r; P iA :.0 $10.00 - Residential •
p. o. Box 117 9 4 --
• ,z, �� $25.00 - Non-Residential
Southpld, New York 11971o r ���,`
Telephone : 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE -SvVi a �; /yft• —_
OWNER NAME: SIAFf'OL-k a0U.NT4 OJ3TLDIJRL____ 3F�n1tC
OWNER MAILING ADDRESS: (o (..JEST 02No 6-ntee-r
• _ZoeRHEAt))__N-�.
OWNER PROPERTY ADDRESS: 10900 ,04181444% R0645? }
�-cr�'rU.cK_T o.IEW uo�� IIgc2
OWNER TELEPHONE NUMBER:, (56)727--2960
Dt5t 143
TAX MAP NO. : Section Block y Lot Q.
CROSS STREET: 1341 gVE/UU&_
TYPE OF SYSTEM: Septic Tank New Existing ✓ _
Cesspool New Existing
Residential Non-Residential
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.)
1 fc.fE ?IS4/0ir
Signature f Applicant
RECEIVED BY: L 4'' / __
Tow Clerk's Office
. / R
i
O
4.0
Era vtE
'-n r3 2'---32'---
MAIa
$u lLD•tPv6
k
(-0 ,
10'100 MA-argil 'RV 7
Ih PtI7 tT U,L l<
fi.1?14/ '
‘iK.._
11
L -SZ sA -- cf ii0l, N M/4