HomeMy WebLinkAboutMyers, Ruth TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG. a
[ ] FOUNDATION 2ND [ ] INSULATION
[ ]
FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
FIRE RESISTANT CONSTRUCTION [ j FIRE RESISTANT PENETRATION
REMARKS:
CD 1
DATE 07 INSPECTOR
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ELIZABETH A.NEVILLE O Town Hall, 53095 Main Road
TOWN CLERKH x P.O. Box 1179
REGISTRAR OF VITAL STATISTICSO Southold, New York 11971
W
MARRIAGE OFFICER • QQ`� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone(631) 765-1500
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
4-
CESSPOOL or SEPTIC TANK
Residential $ 0 or Non-Residential @ $25_ Application No. 1
Permit No.
Owner Name ei-S
Owner Mailing Address
Owner Property Address (C Cl/ll
R IIgS�.
Owner Telephone No.
Tax Map No: Section Block n Lot
Cross Street &A �.a l
Please check each that applies: New Construction
Alteration to Existing System _
Residential V 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.
^ Signature of Applicant ate
Receivedby:
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OF SO(/r�ol
ELIZABETH A.NEVILLE,RMC,CMC O Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N Southold, New York 11971
MARRIAGE OFFICER • COQ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Oly Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER COU 1�,� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4397-R Residential X Non-Res i
Fee $ 10.00 New Existin
Name Of Owner RUTH M MYERS
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Mailing Address 1 1500 WICKHAM AVENUE
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Mailing Address 2
------------------------------
City St Zip MATTITUCK NY 11952-1612
-------------------- -- ----------
Property Address 1 1500 WICKHAM AVENUE
------------------------------
Property Address 2
------------------------ -----
City St Zip MATTITUCK NY 11952-1612
-------------------- -- ----------
Owner Telephone No. 631-298-8215
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Tax Map No. section 139.00 block 3 lot 45.000
------ --- ------
Cross Street ROUTE 48
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Issue
---------------------------------------------------------------
Issue Date: 8/13/09 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
-
- hyo oGy -
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK W Z P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS S: � Southold, New York 11971
-6145,
RECORDS MANA MANAGEMENT OFFICER RIAGE OFFICERy�Ol JaO�� TelephFax one e 63 65765 -800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net -
OFFICE OF THE TOWN CLERK ;
TOWN OF SOUTHOLD l
-SOUTHOLD WASTEWATER DISTRICT
APPLICATION f
• J
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential $10 or Non-Residential 25 Application ✓
,@ @$ pp icahon No.
Petmit No.38�,
Owner Name Ra rN M1��1es
Owner Mailing Address 0-06 kfLk.4,4mi/E/t�KE
M A•TT z T4 C R . Ply /193'2-jQ 7_
Owner Property Address .644M le
Owner Telephone No. X31 " 9 8- 213'
sCrosTax Map No: Section 1.39 Block Lot_V5-
Cross
s Street '-RdU-rrL Alf
Please check each that applies: New Construction -
Alteration to Existing System- ✓
Residential Y 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.)
Signature of Applicant Date
Received by:
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