HomeMy WebLinkAboutBochner Y
OF SO(/r�,®l
ELIZABETH A.NEVILLE,RMC,CMC O Town Hall, 53095 Main Road
TOWN CLERK l l P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS N ae Southold, New York 11971
MARRIAGE OFFICER • �O Fax(631) 765-6145
RECORDS MANAGEMENT OFFICERTelephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER oUNTy,�c� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER. DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4404-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MEL BOCHNER/LIZBETH MARANO
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Mailing Address 1 108 FRANKLIN STREET
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Mailing Address 2 �
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City St Zip NEW YORK NY 10013-0000 1
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Property Address 1 12455 MAIN BAYVIEW ROAD
Property Address 2
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City St Zip SOUTHOLD NY 11971-0000
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Owner Telephone No. 917-912-6838
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Tax Map No. section 88.00 block 1 lot 12.000
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Cross Street MIDLAND PARKWAY
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Issue Date: 10/19/09 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
ELIZABETH A. NEVILLE �� y� Town Hall, 53095 Main Road I
TOWN CLERK r�i� P.O. Box 1179 1
REGISTRAR OF VITAL STATISTICS O Southold, New York 11971
MARRIAGE OFFICERy �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER d �a� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
r OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
�J 10. SOUTHOLD_WASTEWATER DISTRICT
q,oAPPLICATION
J.
L[C) OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10_X_or Non-Residential @$25 Application No. '7'
Permit No. 3?S `4
Owner Name N14 B o c, h er + L,Zb e_"k n/1 a Y�cyy�-b
Owner Mailing Address 109 T:1r'o Yh � 4�r 5 ~
6j L fu 1 001-3
Owner
01-
Owner Property Address 1 .2 Lj 55 M O,i V\ 1-3 AY O►e RC)
S o c,��-1�, o f cQ , ►y y 1 1 � �- 1
Owner Telephone No. 1 I 1 ' 6 V 3 S
Tax Map No: Section FS Block ( Lot 1 2-
Cross
Cross Street rA i d ( aha ar BCW LJ\,
Please check each that applies: New Construction
Alteration to Existing System K
Residential_(Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
Ip _ 'o
SignAute of Applicant Date
Received by:
u.
Mel Bochner & Lizbeth Marano
12455 Main Bayview Road, Southold
00
Lpi
7
y
s
New system consists of: 1 - 1500 gallon septic tank #
2- 8'diameter x 8' deep cesspools