HomeMy WebLinkAboutF&F Mangement '9. //,///I///i,,y.'
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® rP.O. Box 1179
REGISTRAR OF VITAL STATISTICStri Southold, New York 11971
MARRIAGE OFFICER s V. ,$� Fax (516) 765-1823
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Telephone Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3041-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner F & F MANAGMENT CO.
Mailing Address 1 21 ELLEN PLACE
Mailing Address 2
City St Zip KINGS PARK NY 11754-0000
Property Address 1 200 NAUGLES DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-269-0783
Tax Map No. section 99.00 block 4 lot 22.000
Cross Street COX NECK ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/11/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold Application No. 30(0
Judith T. Terry, Town Clerk rz ? '` y
. �G $10.00 - Residential V
Hall, 53095 Main Road � .� „
P. O. Box 1179 v' ' �: % $25.00 - Non-Residential
Southold, New York 11971 a45zi4414r -at�$
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Telephone = -
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /e3ra3
DATE 6/4/i3
4/i3
OWNER NAME: Fok F �/9 /e,r17- (o
OWNER MAILING ADDRESS: (-2/ � PZ.4/6
OWNER PROPERTY ADDRESS: ;zoo pi77--ez, - � ' /2jV,/•4/0
OWNER TELEPHONE NUMBER: - 078_
TAX MAP NO. : Section 7? Block Lot 2,
CROSS STREET: co >c_. iV EC/< /.D
TYPE-OF,-SYSTEM: Septic 'Tank - ' -- New Existing
Cesspool New Existing
• Residential L Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7
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.)
ignature of • pplicant
RECEIVED BY: C�s �0�-� - -
Town Clerk's Office
DATE: - /0 ��
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