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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 ------------------------------ Mailing Address 1 P O BOX 37 ------------------------------ Mailing Address 2 ------------------------------ City St Zip MATTITUCK NY 11952-0000 -------------------- -- ---------- Property Address 1 95 FACTORY AVENUE ------------------------------ Property Address 2 ------------------------------ City St Zip MATTITUCK NY 11952-0000 -------------------- -- ---------- Owner Telephone No. 631-298-4040 ------------ Tax Map No. section 122.00 block 6 lot 9.000 ------ --- ------ Cross Street ROUTE 25 ------------------------------ ---------------------------------- Issue Date: 12/10/12Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) N o��S�fFO�,�coG ELIZABETH A.NEVILLE �� y� Town Hall, 53095 Main Road cz 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 P 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.) ZfU c Signature of Applica Date Received by: f 7 � 6L)i L Di ,j 6 3i%L 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 ------------------------------ Mailing Address 1 45 CLOCK TOWER LANE ------------------------------ Mailing Address 2 ------------------------------ City St Zip OLD WESTBURY NY 11568-0000 -------------------- -- ---------- Property Address 1 8960 PECONIC BAY BLVD ------------------------------ Property Address 2 ------------------------------ City St Zip LAUREL NY 11948-0000 -------------------- -- ---------- Owner Telephone No. 000-000-0000 ------------ Tax Map No. section 126.00 block 5 lot 6.000 ------ --- ------ Cross Street BRAY AVENUE ------------------------------ ---------------------------------- Issue Date: 12/12/12 Elizabeth A. Neville -------- Southold Town Clerk C -301 (TOWN SEAL) fj � // 9y7 �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.) - A fZ // Signature of App icant Date Received by:l l L r i is — I �F E id #a a/I e-) Av --------- ----------__.. . _- ___________ _.______-- -