HomeMy WebLinkAboutBurns, Arthur ' 0,�S�FFOL4-`' Co,o
JUDITH T.TERRY •�� y�c Town Hall, 53095 Main Road
TOWN CLERK y Z •• P.O. Box 1179
REGISTRAR.OF VITAL STATISTICS
° 47$
1 Southold, New York 11971
MARRIAGE OFFICER %=y.s se 1/1' Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER : ....-. j ,,1 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. 1740 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : WILLIAM KELLY
Address 1 : 22355 COX LANE, UNIT #4
City St Zip CUTCHOCUE NY 11935
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. REF #R10-97-0117
Name Of Owner BURNS, ARTHUR AND BERNNIDETTA
Mailing Address 1 P. O. BOX 293
City St Zip MATTITUCK NY 11952
Property Address 1 3450 PRIVATE ROAD #13
City St Zip MATTITUCK NY 11952
Tax Map No. section 105.00 block 1 lot 4.000
Cross Street RUTH ROAD
Building Permit Number Cross Reference:
Issue Date: 10/01/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
„i•,,,,,...
7 YY
JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK C/2
P.O. Box 1179
t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �1� Fax(516) 765-1823
MARRIAGE OFFICER ij' 0.�I
RECORDS MANAGEMENT OFFICER �.( `t►� � Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER •� ,����
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 30, 1997
Transmitted herewith is a copy of application No. 1814 for a Cesspool/
Septic Tank Construction Permit submitted by:
Bill Kelly for Bernnidett Burns •
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 re mmendations:
APPROVE
DISAPPROVE
Comments:
RECEIVED
SEP 2 9 1997
ignature
Southold Town Cle l° to
Dated
lrouttutio.
oFFICEOFF1111 TOWN CLERK »V 9i:F A- •
low,, of Southold
Judith .1 . Terry, Town Clerk Am)lic:ntiou No.
Town Hall, 511095 Main Road construction__
tn
P. 0. Box 1119 •
Alteration
Soulhold, New York 11971 • 1* • . . . . .
Telephone * $iv( • • Residential 4••'V
' 1-
(516) 765-- 1901 -;tzi,711111
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL Dis-ruICT
APPLICATION
re J, •,..,ent
1(11'
CONST R UCT ION or ALTERATION PriumiT
snrIc TANK or CESSPOOL 239 Z--
Permit No.
Feu $
I)NFL'.
A I'l'1_1CANT NAME: ?:-.)F.eov,rit ....-r7 Et.e.A3 Me-/44'
APPLICAN I. ADDRESS: p. 0 IrDx Z-C7 • c;>7 07 3 Ss- g ZA)
siEpT k, CESSPOOL X CCe5K,
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DESCRIPTION OF PROPOSED CONSTRUCT ION OR ALT E R AT ION
_ADD_ & JLI 017441---V4- 44-Pgajef
- ----• •
LOCATION MAI': Must be attached hereto before permit way be Issued.
LOC:A.11011 OF PROPOSED CONSTRUCTION OR A LT ERAT ION:
OWNER OF PROPERTY : eT/ .-.S1fr.aakreri
OWNER MAILING ADDRESS: Pea :-3CSX Z93 Miterra--7eXg__
OWNER PROPERTY ADDRESS : 3qS- ) PATWITL.
..... ci
TELEPHONE NUMBER OF CONTACT PERSON : 7 3e--/ -
.1 AX MAI' NO. : Section Block / Lot 2-/
CROSS STREET : )7 / "gb .
BUILDING PERMIT NUMBER CROSS REFERENCE : a.- 91-1Z-4Z
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RECEIVED BY : k •
DATE :
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516-727-2303 4g
Alden W. Young, P.E & L.S. (1908-1994) §4
Howard W. Young, Land Surveyor rat
Thomas C. Wolpert, Professional Engineer
Kenneth F. Abruzzo, Land Surveyor
John Schnurr, Land Surveyor
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CERTIFICATION
"I AM FAMILIAR WITH THE STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE
SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES AND WILL ABIDE BY THE CONDITIONS °
SET FORTH THEREIN AND ON THE PERMIT TO CONSTRUCT."
APPLICANT'S SIGNATURE:
APPLICANT: •
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NUMBER: c
X!EE
ES 4E
<W
•
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES S�
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. PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
•
RNCLE FAMILY RESIDENCE ONLY d k
DATE 472E-Q7 HS REF.NO. 1O-4Z-0 tL7 /Y,
-
APPROVED S-
"` FOR MAMMUM OF B RC OMS <`:
EXPIRES THREE YEARS FROM DATE OF APPROVAL S I
.„,0.•-
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TEST HOLE
DATE: 07/18/97
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