HomeMy WebLinkAboutFounders Village P' irf=i1 4 Town Hall 53095 Main Road
k 0 ',. �`
P.O. Box 1179
®��', Southold, New York 11971
JUDITH T.TERRY ''''''-z-;!_,,,,/,04--. Doe FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 1332-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner FOUNDERS VILLAGE HOMEOWNERS
Mailing Address 1 ASSOCIATION
Mailing Address 2 1555 YOUNGS AVENUE
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 2555 YOUNGS AVENUE
Property Address 2
City St Zip - SOUTHOLD NY 11971-0000
Owner Telephone No. 000-000-0000
47 Opo
4—
Tax Map No. section . 06-- block 1 lot —1 .0007
63, / ---
Cross Street TRAVELER STREET
Date Of Last Pump Out 0/00/00
Issue Date: 12/05/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
ie
OFFICE OF THE TOWN CLERK SFFO(,-
Town of Southold CQ Application No. /33 2--
Judith T. Terry, Town Clerk F t Z
Town Hall, 53095 Main Road '1� :` $10.00 - Residential
P. O. Box 1179cn ;$ 44z $25.00 - Non-Residential
Southold, New York 11971 P2-46
-
Telephone ( y► '�
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
•
DATE Nov. 20, 1989
OWNER NAME: FOUNDERS VILLAGE HOMEOWNERS ASSOCIATIONt • •
OWNER MAILING ADDRESS: 25$5 Youngs Avenue
Southold, N.Y. 11971
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 063C,1-_,-- Block 01 Lot 01
CROSS STREET: Youngs Ave.
TYPE OF SYSTEM: Septic Tank X New Existing x
Cesspool New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: None
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.)
Siiaan�aVt'ire of App icant
President, FVHA
RECEIVED BY:
Town Clerk's Office
DATE:
s
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