HomeMy WebLinkAboutFriedman SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4441-R Residential X Non-Residential
Fee $ 10.00 New X Existing
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Name Of Owner JOEL FRIEDMAN--- -------------- �lz
Mailing Address 1 6 COLD SPRING HILLS ROAD
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Mailing Address 2
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City St Zip HUNTINGTON NY 11743-0000
Property Address 1 830 CLEARVIEW ROAD
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Property Address 2
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City St Zip SOUTHOLD NY 11971-0000
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Owner Telephone No. 917-744-7555
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Tax Map No. section 89.00 block 3 lot 11.005
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Cross Street CEDAR POINT DRIVE
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Issue Date: 8/14/12 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE �V y Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICSO Southold, New York 11971
MARRIAGEFax(631)
RECORDS MANAGEMENT OFFICER y��• �aO�� Tele hone(63) 7654
P 1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10-1>(or Non-Residential @ $25 Application No. L4 l
Permit No. �
Owner Name
Owner Mailing Address L'0 LD 45pwG- Mz,&5 0&3,90
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Owner Property Address 030 aagi)—Idj
60yvf OLID AM
Owner Telephone No. C1 5S-
Tax Map No: Section (M Block Lot . 005
Cross Street AZ
Please check each that applies: New Construction
Alteration to Existing System
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 s y with SCHD approval.)
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Signature of Applicant _ Date
Received by: ��/
Jeffrey T. Butler, P.E. , P.C. 206 Lincoln Street
Architectural and Engineering Services Riverhead, NY 11901
Tel: (631) 208-8850
Fax: (631) 727-8033
August 7,2012
VIA U.S.MAEL
Office of The Town Clerk
Town of Southold
Town Hall
P.O. Box 1179
Southold,NY 11971
RE: Operation Permit—830 Clearview Road(1000-89-3-11.005)
To Whom It May Concern:
Enclosed,please find a fully executed Application for Operation Permit for the above referenced
property. Also enclosed is a final survey with the location of the new sanitary system and a check
for$10.00. Please mail the Operation Permit to my attention at the address above.
Should you have any questions,please do not hesitate to contact me.
Sincerely,
Melissa C.Butler
Enclosures
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