HomeMy WebLinkAboutKoch SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4448-N Residential Non-Residential X
Fee $ 25.00 New Existing X
Name Of Owner KOCH HOLDINGS CORP
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Mailing Address 1 P O BOX 37
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Mailing Address 2
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City St Zip MATTITUCK NY 11952-0000
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Property Address 1 95 FACTORY AVENUE
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Property Address 2
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City St Zip MATTITUCK NY 11952-0000
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Owner Telephone No. 631-298-4040
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Tax Map No. section 122.00 block 6 lot 9.000
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Cross Street ROUTE 25
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Issue Date: 12/10/12Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �� y� Town Hall, 53095 Main Road
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TOWN CLERK co Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O Southold, New York 11971
MARRIAGE
MANAGEMENT OFFICER y��• �aO�� Tele oFax n5 4
Telephone( 6331) 165
RECORDS 1800
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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 or Non-Residential @ $25 Application No.
Permit No.
//0Owner Name Q L O sL
Owner Mailing Address I L/ 6 0 X3 7
Owner Property Address ro t,-TV, U c:
Owner Telephone No. ec .5 j .�q e '7' V o
Tax Map No: Section 12 7,04cblock Lot
Cross Street e 7r 62 s---
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 survey with SCHD approval.)
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Signature of Applica Date
Received by:
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SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4449-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner JAMES & JANET D'ADDARIO
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Mailing Address 1 45 CLOCK TOWER LANE
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Mailing Address 2
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City St Zip OLD WESTBURY NY 11568-0000
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Property Address 1 8960 PECONIC BAY BLVD
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Property Address 2
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City St Zip LAUREL NY 11948-0000
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Owner Telephone No. 000-000-0000
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Tax Map No. section 126.00 block 5 lot 6.000
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Cross Street BRAY AVENUE
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Issue Date: 12/12/12 Elizabeth A. Neville
-------- Southold Town Clerk
C -301 (TOWN SEAL)
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�1r4,S11FF01,rc
ELIZABETH A.NEVILLE y� Town Hall, 53095 Main Road
TOWN CLERK y = P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS O Southold, New York 11971
MARRIAGE OFFICERy • �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ! `1►aO Telephone (631) 765-1800
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 or Non-Residential @$25 Application No. 441�
Permit No. �'
Owner Name -S4_me4-,u cfrA JJA12ia
Owner Mailing Address 5 �loce 7e44--�e2 4'�-t..
6/� CJ es du/y A)-X //56,9
Owner Property Address 9-$60 Pec 4 N cc. ,gam R/A
Z,44(4-el y I f 5r y
Owner Telephone No.
Tax Map No: Section 2 06 Block Lot �'OC6
Cross Street 12 y
Please check each that applies: New Construction
Alteration to Existing System /V
Residential t-'*'
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.)
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Signature of App icant Date
Received by:l
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