HomeMy WebLinkAboutShip, John H /',#,
JUDITH T.TERRY l= y� •
Town Hall, 53095 Main Road
TOWN CLERK ; N Z ; P.O. Box 1179
Southold,en New York 11971
REGISTRAR OF VITAL STATISTICS1�'
MARRIAGE OFFICER `.1/4 y� aO 'II Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER 49.( �
+ `�► ff Fax
(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. 65 N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
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 SHIP, JOHN HENRY AND JOANNE
Mailing Address 1 P. O. BOX 1013
City St Zip MATTITUCK NY 11935
Property Address 1 MICHELLE'S BEAUTY SALON
100 GRAND AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 1110.00 block 2 lot 19.000
Cross Street
Building Permit Number Cross Reference:
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Issue Date: 3/21/96 Judith T. Terry``
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY t�= yet own Hall, 53095 Main Road
TOWN CLERK % y = P.O. Box 1179
" t Southold,New York 11971
:
REGISTRAR OF VITAL STATISTICS O �
� Fax(516) 765-1823
MARRIAGE OFFICER ,y 4, a�� ��
�*....0. Telephone Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER l lig *`..
FREEDOM OF INFORMATION OFFICER '''''''•'....01s°
OFFICE OF THE TOWN CLERK f' i , .r,.
TOWN OF SOUTHOLD _, ''
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 11 , 1996
Transmitted herewith is a copy of application No. 1504 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for 100 Grand Ave. Ltd. (Michelle's Beauty.Shop)
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.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the followingi � recommendation:
APPROVE - v
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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OFFICE OF THE TOWN CLERK ,,'''""" /1 •
Town of Southold ;''' OM/re" Application I�fo�'/SQ
Judith T. Terry, Town Clerk ��' Gy
Town Hall, 53095 Main Road � � _ Construction
P. O. Box 1179 1 c. n+ 1 Alteration
Southold, New York 11971 �$
Telephone ._ ,
f4.7 '''''' $10.00 - Residential
(516) 765-1801 : 1 4 ;, ' $25.00 - Non-Residential l/
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 0-//-94
APPLICANT NAME: --e-C-0 i c..
APPLICANT ADDRESS: / e, 6-,-G 472_
r �J
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
et. 01/P. c,v--y-t,-,___( 07,-g-w-,efirj-1,1_, . --1--- -62- ..k_i
,...504...1.4--an..7„)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Reiou T� Ski
OWNER MAILING ADDRESS: J( . _ AAA. , AOr j/ " /0(9
C iccC- a, j Ave , L-r, )
OWNER PROPERTY ADDRESS: /.... 4A./. , a ,r. ,e_A_,,
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section PI D Block Lot / 7
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
s -.1-( 1- e- --4Signature of Ap cant
RECEIVED BY: 4 PAI /4
•wn Clerk's Office
DATE: / ,IM •
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