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HomeMy WebLinkAboutShiloh Baptist Church /e001- SUFFO(t0 'y� G JUDITH T.TERRY y. Town Hall, 53095 Main Road TOWN CLERK 1 y z t P.O. Box 1179 ^r 1 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER :‘�* ���1�' Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER : �.� `1►a�d 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. 71 N Residential Non-Residential X Fee $ 25.00 Septic Cesspool X PERMIT ISSUED TO: Name : MORRIS CESSPOOL Address 1 : 2760 YENNECOTT DRIVE City St Zip SOUTHOLD NY 11971 Descripton of Proposed Construction or Alteration ADDITION OF AN OVERFLOW TO AN EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner SHILOH BAPTIST CHURCH Mailing Address 1 P. O. BOX 201 City St Zip SOUTHOLD NY 11971 Property Address 1 NORTH ROAD City St Zip SOUTHOLD NY 11971 Tax Map No. section 135.00 block 3 lot 22.000 Cross Street GROVE DRIVE Building Permit Number Cross Reference: Issue Date: 5/24/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) '/'.,, iii,1... . - ' ,I.1IO\OSVFFo��'CO*..4, . yJ► Town Hall, 53095 Main Road JUDITH T.TERRY ��=� 4 TOWN CLERK ; ti x P.O. Box 1179 a, � $ Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER �'jijJ 0� �1�, Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER 91 *�0d. Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER ,," OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda Cooper, Southold Town Clerk's Office DATED: MAY 14, 1996 Transmitted herewith is a copy of application No. A1545 for an ALTERATION PERMIT for a cesspool or septic system submitted by Morris Cesspool for Shiloh Baptist Church . 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. Cel-i4-4 —`1-- Linda J. Cooper * * * * * * * * * * * * * I have reviewed the application and location map of the project listed above and make the following recommendation: APPROVE - 1-- DISAPPROVE - COMMENTS: Maintain required setbacks from adjacent wells, buildings, property lines and water bodies. EXCAVATION INSPECTION REQUIRED. RR R ry� R , ' l5 l5 O ll L5 11 . `! , 2- , c�; i r �, Signatur: MAY 1 $ 1996 i "', _ .�� 3/:c Dat . TOYMBVDOVDSOLD OFFICE OF THE TOWN CLERK """"•- Town of Southold Judith. T. Terry, Town Clerk Application No. /.S Yc Town Hall, 53095 Main Road Construction P. O. Box 1179 AIAlteration Southold, New York 11971 .. Telephone � $10.0 ' esidential P (516) 765-1801 1 414 , '`' $ .00 - 'on-Residential • -- , TOWN OF SOUTHOLD SOUTHOLD WASTEWATER' DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE / APPLICANT NAME: fr."1-- � APPLICANT ADDRESS: c.0 ?6:O go< SEPTIC CESSPOOL/ DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCT N 0 ALTERATION: OWNER OF PROPERTY: OWNER MAILING ADDRESS: "ef---atk- / U� £k 2d/ c_ �/Z Y OWNER PROPERTY ADDRESS: TELEPHONE NUMBER OF CONTACT PERSON:? ���� TAX MAP NO. : Section /...SSS Block 3 Lot 22 CROSS STREET: BUILDING PERMIT NUMBER CROSS REFERENCE: ,21)0J7-1/4 Signature of Applicant RECEIVED BY: Town Clerk's Office DATE: Lijz. , Id e,„aty-zreyi° clA bj. ;