HomeMy WebLinkAboutNF Housing Alliance .11114 01./reAl
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JUDITH T. TERRY. ; 1. Town Hall, 53095 Main Road
TOWN CLERK v T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER � o. ,. Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3150-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner NORTH FORK HOUSING ALLIANCE
Mailing Address 1 - 18 SOUTH STREET
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 WALNUT AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-477-1070
Tax Map No. section 142.00 block 1 lot 12.000
Cross Street FACTORY AVENUE
Issue Date: 11/29/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i ' '_'.
OFFICE OF THE TOWN CLERK ' �FF1
Town of Southold %�._, CQ Application No. 3 /•-s-0
Judith T. Terry, Town Clerk • A `; $10.00 - Residential ��
Town Hall, 53095 Main Road r
p. O. Box 1179 un Vki • $25.00 - Non-Residential
Southold, New York 11971 O�yw� �"`y-�Og�`•
Telephone .( / •
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ///,/,'s—/?0
OWNER NAME: /14r �r ie. ,41-1-S./4)4 1 /./.'Riyr► 22-
OWNER MAILING ADDRESS:
Gr.Pew/00)-7z- // Y // 99�/
OWNER PROPERTY ADDRESS: 6I/y /Nu71- /,1.e i
/ fr '71uei fit/ /1 9.5
OWNER TELEPHONE NUMBER: y77 -/ 7Q ,
TAX ,MAP NO. : Section /y2 Oa Block / Lot /2, 600
CROSS STREET: /- `q - 42 'M,/ Q---
TYPE OF SYSTEM: Septic Tank !/ New Existing
•
Cesspool ✓ New Existing
Residential Non-Residential
i
DATE OF PREVIOUS PUMP-OUT:
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.)
rer."4,1_,,A, / /
Signature o• Applicant
RECEIVED BY: ("Cjilli -------
own Clerk's Office
DATE: / /9--
/re / 93
i
rrau, (DWELLINJ
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The locations of was and cesspools shown hereon are 1r":^ 5•:'7* i_p
AREA a 5,959sa.f! observations and or from data obtained from others. —'
- The water supply and sewage disposal
Prepared/n accordance with the.minimum systems for this residence will conform •
standards for Lille surveys as established to the standards of The Suffolk County
by the LJ.A.L.S and approved and adopted - Department of Health Services.
for such use by The New York. Stole Land
TI/fe Association.. - '