HomeMy WebLinkAboutCollins, Carol o,'''StFF014,-
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JUDITH T.TERRY it _ yt'. Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %%°O 471
Fax (516) 765-1823
MARRIAGE OFFICER 4, .��O'a'
Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER - 1 4 �►
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. 1568 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GENDOT ASSOCIATES
Address 1 : P. O. BOX 847
City St Zip WADING RIVER NY 11792
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. #R10-96-0093
Name Of Owner COLLINS, CAROL
Mailing Address 1 453 MILL CREEK RAOD
City St Zip BIRD IN HAND PA 17505
Property Address 1 SELAH LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 9 lot 4.003
Cross Street COX NECK ROAD
Building Permit Number Cross Reference:
Issue Date: 11/15/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �'_� y��` Town Hall, 53095 Main Road
TOWN CLERK i y = P.O. Box 1179
k 471
,i Southold, New York 11971
MARRIAGE OFFICER y 1
REGISTRAR OF VITAL STATISTICS ��1 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER -%0.( *via" Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER --.. � os°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 6, 1996
Transmitted herewith is a copy of application No. 1634 for a Cesspool/
Septic Tank Construction Permit submitted by:
Gendot Associates for Carol Collins
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.
7
Linda J. Cooper
* * * * * * * * * * * *
1 have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE j
Comments: ���f'/ �C ..' ` 7°r 76. `.009
RECEIVED (- /
51996 Signatur�
NOV4t4( 11
� / ;� /96
Dated
Southold Town Clerk
4.
OFFICE OF THE TOWN CLERK ooG"
Town of Southold �•''�1c,I 0111 `'O =, Application No. /'
Judith T. Terry, Town Clerk /44".`
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y+` PP 4� 3Town Hail, 53095 Main Roadmac, .
z. • I Construction 1---
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P. 0. Box 1179
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Southold, New York 11971 %to1� �• Alteration
Telephone `o���0 ��Q�'.!� $10.00 - Residential L�
(516) 765-1801 _ 1 ' $25.00 - Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE //J0q/ / 0
APPLICANT NAME: at/=
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