HomeMy WebLinkAboutMartz, Theodore CTown Hall, 53095 Main Road
P_O. Box 1179
Southald, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
FROM:
Linch J. Cooper, Southold Toxxm Clerk's Office
DATED: June 22, 2004
Transmitted herewith is a copy of application No. 3338
Permit submitted by:
for a Cesspool/Septic Tank Construction
Theodore C. Martz, Jr.
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit,
Please complete the form below and retm'n it to me.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Signature
Dated
ELIZ4_BETH A. NEVILLE
~ £0~,~ CLERK
REGI~TtLAR OF %-ITAL STATISTICS
· I,[Al~l%IAGE OFFICER
RECORDS ]%IA/qAGEMENT OFFICER
FREEDOM OF INFOI{3L&TION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
...... Fax (~.~ 76~-0145.
Telephone (631) 765-1800
souiholdtown.northfork.net
OFFICE OF THE TO%%rN CLERK·
TO%%~N OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 X or Non-Residentia] ,~:' $25 ___
Applicant Name Theodore C. ~iartz Jr.
Applicant Mailing Address 145 Ryerson Avenue
Manoz-ville, NY 11949
Septic Tank or Cesspool
Brief Description of Proposed Construction or Aheration
new system
Application No.335£
Perm/t No.
Location of Proposed Constnlction/Alleration:
Owner of Property: Alfred E. Kunsch c/o Joseph LaCapra, esq.
O~mer Mailing Address: 1213A Main st. P0 Box' 504
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section 111
Cross Street Hay,rater Road
Oakdale, New York 11769
275 Wes% Cove Road
Cutcho~ue, New York
(631)-878-8443. T. Martz Jr.
Block 03 Lot 04
NOTE: LOCATION 5LAP I~fLTST B~E~ S tJBMITTED WlTR
CONSTRUCTION REQUIRES SURVEY IVITH HE.A.L-T~ DE.P..Atl'T~T)APPRpX~AL/
"- Si~mlature of ApplicJ ~/~/fl Date'
Received by: .'~F'