HomeMy WebLinkAboutGilbert, Betsy Kennedy 001°
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JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK ; y = P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER -r4Oa0veoe Fax(516)765-1823
RECORDS MANAGEMENT OFFICER : l `►.••I' Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 66 N Residential Non-Residential X
Fee $ 25.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SHELLEY KEHL
Address 1 : 28545 MAIN ROAD
City St Zip ORIENT NY 11957
Descripton of Proposed Construction or Alteration
ALTERATION WITH SCHD APPROVAL.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner GILBERT, BETSY KENNEDY
Mailing Address 1
City St Zip 0000
Property Address 1 MAIN ROAD
SHELLEY'S PLACE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 62.00 block 3 lot 7.000
Cross Street HOBART AVENUE
Building Permit Number Cross Reference:
Issue Date: 3/21/96 Judith T. Terr'
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY 1 Town Hall, 53095 Main Road
TOWN CLERK y Z ; P.O. Box 1179
• W �t� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS % G 1
MARRIAGE OFFICER .o& 0-�1� Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER V! * 'Oa" Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ...-�
OFFICE OF THE TOWN CLERK �
TOWN OF SOUTHOLD 0 (2-
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 13, 1996
Transmitted herewith is a copy of application No. A1505 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Shelly Kehl for "Shelly's Place" .
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
. .f---1--x,--e--t
Linda J. Cooper
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I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
MAR '. 3 lr"' Si•natur- OF
Date
01 FICE OF THE TOWN CLERK ,,,,,,,,""
Town of Southoldtf akt =
�'J Application No. Q S
Judith T. Terry, Town Clerk ;' G
Town Hall, 53095 Main Road r4Construction
P. O. Box 1179 ; o rn ; Alteration
Southold, New York 11971 �� �;
Telephone 0 ��' $10.00 - Residential
(516) 65-18011 0„ $25.00$25.00 -Non-Residential•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ ...2 S
—
DATE
APPLICANT NAME: ghelire.,
APPLICANT ADDRESS: c 2 545 1 Y tA-(
6RteKr / nut 51
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
64, 7-- E4 Teo — / Sea �
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONS CTION ORA TERATION:
OWNER OF PROPERTY: 1 \kxT
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: `f"Yt �ccti Qej. (a,
TELEPHONE NUMBER OF CONTACT PERSON: 3c)3 - 31/4.5X7
TAX MAP NO. : Section Block Lot
CROSS STREET: al I Q, H i /-Iobo4i'? VQ--
BUILDING
PERMIT NUMBER CROSS REFERENCE:
Sip(' ature of Ap Iicant
RECEIVED BY: D�(q,P
Town erk's Office
DATE: 3/ f.,
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5 P--ILLEY K E-I-IL !
StIl.FOLli COUNTY DEPARliVIENT OF HEALTH SERVICES
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APPROVED FOR CONSTRUCEION ONLY
H.S. REF. NO. C/° - '76 / FL'OW
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1 . 1 This approval is granted for the construction of the sanitary
dif..pwal Dori wale; ,svpIll.y familt:es toirsulit to Articles VB and
• 7 of the Stiriolk Ccuilty S.,hitaty Code;:nd is not an expressed
nor implied z.Ipproaal to dit:charge from or occupy the
1----- - --structute(s) shown.. _THIS APPROVAL EXPIRES MO (2) YEARS
FROM TH. DAT• BELOW.
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