HomeMy WebLinkAboutBarry, William 7c ' cure N
0,
> i Town Hall, 53095 Main Road
0P.O. Box 1179
y �0 Southold, New York 11971
JUDITH T.TERRY 1��.,\1 4. Southold,
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1577 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : BETTY ANN BARRY
Address 1 : 400 HILL ROAD
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-96-109
Name Of Owner BARRY, WILLIAM AND BETTY ANN
Mailing Address 1 400 HILL ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 500 HILL ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 4 lot 35.000
Cross Street MIDFARM ROAD
Building Permit Number Cross Reference:
Issue Date: 12/12/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY 0 yet 1Town Hall, 53095 Main Road
TOWN CLERK y Z % P.O. Box 1179
% i Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ‘14t X417. Fax(516) 765-1823
MARRIAGE OFFICER �f� 0•0°i� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER 1 * '1►
FREEDOM OF INFORMATION OFFICER • , •i"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 6, 1996
Transmitted herewith is a copy of application No. 1645 for a Cesspool/
Septic Tank Construction Permit submitted by:
Betty Ann and William Barry •
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE ,� C�
Comments: ,�� �is (rd >/ /l /fl' --/o
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Dated
OFFICE`OF THE TOWN CLERK ,C.SFU1,re,"
Town of Southold Application No/h V
Judith T. Terry, Town Clerk ..c it
Town Hall, 53095 Main Road Construction
P. O. Box 1179
Southold, New York 11971 Or
%`' AlterationTelephone _alt �� Residential
(516) 765-1801
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE %6A/9 �o
APPLICANT NAME: t8e ► 1
APPLICANT ADDRESS: 4 O O 14 LL �D AIT
5O tko (d Av /
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
4/E Srn? dc,/Ll1iny
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: a j/1/4Al ,i 15 .711.? ,en,, ,i, egy
OWNER MAILING ADDRESS: 40O //,'LL 4,4
Sou7-4 o/d, y //q7 /
OWNER PROPERTY ADDRESS: .ADD Mi`—t- ?OAl
SootAv/cl, j ,' ' J ( G7/
TELEPHONE NUMBER OF CONTACT PERSON: -765-- '370
.7o SS'
TAX MAP NO. : Section �Y Block Lot
CROSS STREET : �ll`t) Pi/lee-4 •
BUILDING PERMIT NUMBER CROSS REFERENCE:
Si. ature o Applic1/
RECEIVED BY : ��
T lei r--- Office
DATE: /c /' 7/5
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GREENPORT NEW YORK •
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