HomeMy WebLinkAboutSouthold United Methodist Church (3) i
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ELIZABETH A.NEVU",RMC,CMC ti. Town Hall,53098 Main Road
TOWN CLERK P.O.Box 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER Fax(631) 768-6145
RECORDS MANAGEMENT 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. 43860-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SOUTHOLD UNITED METHODIST CHCH
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Mailing Address 1 54020 ROUTE 25
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Mailing Address 2
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City St Zip SOUTHOLD NY 11971-0000
Property Address 1 54020 ROUTE 25
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Property Address 2
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City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-3449
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Tax Map No. section 103.00 block 7 lot 8.000
Cross Street WEST MECHANICAL STREET
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Issue Date: 12/08/08 Elizabeth A. Neville
------ Southold Town Clerk
(TOWN SEAL)
FI,IZAIV;TII A. NEVILIX ��� To'vn Hall, 53095 NTgin (Zoi('
TOWNCLERK tr 2 P.O. BOX 1179
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�`I'GT`�'F aR )t �T AT n" 4 S, vt,hold, New York 11971.
91RT'TACE OFF'(( �� ��`, Fax (631) 765-6146
IJ AOR ),�M ,N GEMEN•I (,FFlr•EIt �� ��� Telephone (631) 765-1800
'NFOR.1\IATIOP OFFIC?I' vsoiit1)oldtown.north fork.net
CII"FTCE O►i FTIE 'TOWN ('1".FRE
TMI V oil, SOUTIi0i11)
SOT'TIIOLD V ASTF,AVATER DISTRICT
AITTACATION
OPI, F k-PION "IERMIT
CESSPOOL or SEPTIC 'LANK
Re�,Ulcrlial (a_� SlCA o, Co S2' - -- Aipl•cattov No.
P('nnit No.
a. 3-7 9
Owner Nalrie
Owncr Mailing Address Q ;LC)
Ov,ncr Property Address__._�_.AM�__-__
Ovv tici—Telephone No.
Tai Map No Section—__a\�— ?31ock �! - Lot A —
Cross Street-
Please
treetPlease clleck each that applies: New (enstruction
Alteration to Existing System
Residential — Non-Residential _
NOTE: LOCATION MAP MUST IAF SUBMITTED WITH APPLICATION. (Locate
building and system: give north arrow and approx'matc distance in F-ct from I ystern to building
and closcst road. N(,Ni const,Zir.tion may slilimit cop_ of;un cy with SCUD approval.)
,tur-e of Anplictnt Date
Rcccivcd hy: _
COASTLINE CESSPOOL & DRAIN SERVICE
4225 Bridge Lane
y. G Cutchogue,L.I.,N.Y. 11935
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SCCA.Lic. #168-LW NYS DEC#tA-600