HomeMy WebLinkAboutBelvedere Property Mgmnt �OF�Ur
EId�T.Ar A.NEMAX �`� Town Hall,53095 Main Road
T10"clim ~ P.O.Box 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
DtANRL40E OFFICER Fax(681) 765-6145
RECORDS MANAGEMW4T OFFICER Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4374-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner BELVEDERE PROPERTY MANANGEMENT
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Mailing Address 1 1251 AVENUE OF THE AMERICAS
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Mailing Address 2
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City St Zip NEW YORK NY 10020-0000
Property Address 1 380 FIRST STREET
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Property Address 2
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City St Zip NEW SUFFOLK NY 11956-0000
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Owner Telephone No. 212-782-7195
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Tax Map No. section 117.00 block 8 lot 1.009
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Cross Street FIRST & JACKSON
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Issue Date: 9/23/08 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
41 V9'�z FFO4Pre
ELIZABE'rH A.NEVILLE i'oNn halt,53050 Main lioa�i
TOWN CLERK P.O.Box 1179
H Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER G� • �`� Fax(631) 765-6145
RECORDS MANAGENIENT OFFICERd Telephone(631) 765-1800
FREEDOMS OF INFORMATION OFFICER � �`�:? southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOIJTIIOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential (u;$10 or Non-Residential tcci,$25 Applicati n No. 7L(
Permit
3�7
Owner Name
Owner Mailing Address IZS 1 _� S �_
AV4 L4 , i tOzO
Owner Property Address —,L.
Owner Telephone No. 7,6Z--
Tax
,6z-Tax Map No: Section 11'7, D_Block _ Lot 1 ,
Cross Street —1 -ii J
Please check each that applies: New Construction _
Alteration to Existing System _
Residential_ X Nan-Rcsidcntial
NOTE: LOCATION MAP MUST BE SUBMITTED WI'TH 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.)
9
Ignature an Date
Received by: __ _