HomeMy WebLinkAboutWarner .i=ce►•
ELIZABETH A.NEVILLE _� OG'y� Town Hall, 53095 Main Road
TOWN CLERK H - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 5 Southold, New York 11971
,fi � !� Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER} Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
�M JUN 1 l 2003 ;L-,,UFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 11, 2003
Transmitted herewith is a copy of application No. 3183 for a Cesspool/Septic Tank Construction
Permit submitted by:
John Fisher for Rev. Warner and Rev Koestline
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 return 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 ✓ t�i��� � C -
Comments:
Signature�4e
/
D
ELIZABETH A. NEVILLE ,``1� Gy Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
co Z Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS
MARRIAGE OFFICER - Oy • �•� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �f Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER O'� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10(-----o--r-
$10(--- or Non-Residential @ $25 Application No.
l Permit No.
Applicant Name T644 P l s qk g-
Applicant Mailing Address q7 Al;e 1TO S •
P,t��1K� N Kor►� .�/.�/�7�lc
Septic Tank or Cesspool
Brief Description of Proposed Constriction or Alteration 600 S8 !�42y
5F X
Location of Proposed Construction/Alteration:
Owner of Property: 61E%). W - _i oF-L WAPJER A)OCL (G 6EtT e-,',JE
- Owner Mailing Address:'-2-7 r Sri,Tk D 2 C .
SOU714w-0 , N.y•
Owner Property Address: 2'7 t) c r A; Tu Q R S
�uT I�o(,U /y•�• .
Name and phone number of contact person 'nReJ Fi S EA 6 3 I- Ai -R 97 3
Tax Map No: /odc) Section Block _ Lot
Cross Street Ma i BAJI Q ACL-1
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Sign e of Applicant
Received by: L ¢vJUN 1 1 2003
Southold_Touun Clo,k,.4
1
-
• AAVIL Q�Nf•,l.1.
O
Mva
Brio �t 10W N °�1°�� 8�` P�P�t.l WATP.R-
-'-2A
- 1
�ETA
4, co I°oo vJ o
cos ��61
PGI- 2`154 �P
TIOAL- WirtLANp- 10H L°r-AT10H f- ►,, o
NT A R f 111
se-
-Cc P4 6 U b-�A 4T1,
G-CcP46Ub-A4T1i TANK-
100,
I 4E� oo,�,�• `' 8'NA 2' urxP oUT� SAN E(S)
b► Dept 4f Health Sery ces / 3
I L C 4k e4 o
j s 6 �, L_ 5.0 I � L ��(�l '}4 I`I l'C �.
2 2 , I ! 12A, 1 2 ( �` 19. ti,aa� 2,b cL^corT 33 - 1 '[
1 Pg, _ vec 3t
i -q Rab,�v� �,�1G� PAOLA 04ALMAfJt-J
Kk+11�1 btu. �pbgk1�RvAiAvtl
A I�o�J;�WA��Y.►�vt�J 1 � 415 F. ,a AAMl�h) 54og P•ti,4►tJ �`�'✓I�
+'AI' i
cf1pi.'A f't5 ?L, 126,2. .QRZ xwt� 21 —
n�� It�!'�'sti..h1� ►I�n>fo� r`� 1 RI.GxP�N Z �--� u 4+e _: � �3 dao —.___.- .-_ _.__ _ -- q
� �u1 '_ - $ GJo�?�o� N `���I i .
l�oC-1�Nr.Uk •,
vy •�1 f .1 Pte/ bw� Y N
I 500 ziMr�4 0� h 610 OeNr��p lNtiv�i. 8 dr, r, ( ,+�, .4�•, F�Mt �
ff: . a.t45
�. _ ._... _._ _. -- — --...__, n{It�V� N. 11°►71 `} I {� oo'� t.�:,; o , a, 1
j - 5.0 2rao ' I
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES '4 S ,C;4 — ----
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A -
r WGLE FAMILY RESIDENCE ONLY
R to
DATE.- '15-0'3 HIS REF.N0. —o2-0(6r7 1 'f P I. .�. ISI Q�• a D 2 'o -0 3 - 34. 3
1 APPROVED �'.,�li� I" � ��_p�; ,
't.10vT14OL-0, r4-y 1-1r,i
FOR MAXIMUM OF_3 BE OOMS j �vr4'-/LY 10 Fo HAT 10 N � M fie7(1-i� 124• 200 1
7s_ IS���EY P26e+►REp g�-AN'(I-�cN Y WI I, �hlA►-toWSKt L,5s�jy���
EXPIRES THREE YEARS FROM DATE OF APPROVAL
I
ff:AVAT101N IN;SpE�1
31 D J o�L FOR SANITARY Syg7
EM
H LTM
A0JAGENT Ae&A ro(Z,oFjr� _ 1l�vo'1,12 Go4.- DEPA
p?0,,1 Ot:� foe.
ADD rTio No.0 p0 ti►- x 2