HomeMy WebLinkAboutAllbobrick Realty ELIZABETH A.NEVILLE •ir * ; Town Hall, 53095 Main Road
TOWN CLERK ® -� P.O. Box 1179
y Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 0 �'�� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER
MARRIAGE OFFICER �\,04, ®�'��� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ,f'�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 171-N Residential Non-Residential X
Fee $ 25.00 New Existing X
Name Of Owner ALLBOBRIK REALTY CORP.
Mailing. Address 1 P. O. BOX 54
Mailing Address 2
City St, Zip MATTITUCK NY 11952-0000
Property Address 1 13400 MAIN ROAD
Property Address 2 (ROY REEVE AGENCY, INC.)
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-11700
Tax Map No. section 114.00 block 11 lot 9.003
Cross Street WICKHAM AVENUE
Issue Date: 12/03/98 Elizabeth A. Neville
Southold Town Clerk •
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK //PFFD ` �/
TOWN OF SOUTHOLD � 1 Application No. / V
ELIZABETH A.NEVILLE,TOWN CLERK ' �� �' $10.00 - Residential
P.O.BOX 1179
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SOUTHOLD,NEWYORK11971 �1��Z $25.00 - Non-Residential
- -- Telephone • ',/),,4 `11 '1
(516) 765-1801 '-
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT : 1
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ h15":
DATE .17- 34(2-98
OWNER NAME: /92. L —863/' 72'," 4-#9Z/ 7 CO,e/O
OWNER MAILING ADDRESS: /... 416040 /i9,4f�4 ,4'3 j ,. .:e2 -'OX.
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/ 7/9/%/ 72,1c /- A/Y Q..57.2
OWNER PROPERTY ADDRESS: /✓g�� -S411 1R//v ROA) 0 PP0s,72—
a4c$-/s9A1AV IE 11/9/%/ /(c/ AlY
OWNER TELEPHONE NUMBER: 6--/ - c9g - .4,z7e0 /
TAX MAP NO. : Section //17/ Block /1 Lot Qo
CROSS STREET: ea/67-{/1-1(9-A7 ,Q ij/
TYPE OF,y,SySTEM. Septic Tank - -. New - _ -- - _ _Existing
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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.)
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Signature of Applicart -:_'�
RECEIVED BY:
Town Clerk's ,Office ,
DATE:
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UNAUTHORIZED ALTERATION OR ADDITION TO
' THIS SURVEY IS A VIOLATION OF SECTION
7209 OF THE NEW YORK STATE EDUCATION
LAW
. \
COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY.
GUARANTEES INDICATED HEREON SHALL RUN
. ONLY TO THE PERSON FOR WHOM THE
SURVEY IS PREPARED,AND ON HIS BEHALF
TO THE TITLE COMPANY,GOVERNMENTAL
AGENCY AND LENDING INSTITUTION LISTED
HEREON,AND TO THE ASSIGNEES OF THE
LENDING INSTITUTION GUARANTEES ARE
' NOT TRANSFERABLE TO ADDITIONAL
INSTITUTIONS OR SUBSEQUENT OWNERS,