HomeMy WebLinkAboutForte, William /•••,
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JUDITH T.TERRY ���_� yL Town Hall, 53095 Main Road
TOWN CLERK ` y = P.O. Box 1179
T 11 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 1, O
MARRIAGE OFFICER NA0� 1 Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER �l * atoo 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. 1505 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : WILLIAM A. FORTE
Address 1 : 687 ARLINGTON ROAD
City St Zip WEST BABYLON NY 11704
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR A NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-96-0027
Name Of Owner FORTE, WILLIAM A.
Mailing Address 1 687 ARLINGTON ROAD
City St Zip WEST BABYLON NY 11704
Property Address 1 1155 HARBOR LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 97.00 block 6 lot 12.003
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 7/15/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ,��_� y1• Town Hall, 53095 Main Road
TOWN CLERK N Z % P.O. Box 1179
%REGISTRAR OF VITAL STATISTICS O $ Southold,New York 11971
MARRIAGE OFFICER :�y4, 0. 0 Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER O,j #0.1"
0.1 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER .0SIP
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD .6 96
--D LDG. DEPT.
TO: Southold Town Building Department -
TOWN OF SOUTHOLD I
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 5, 1996
Transmitted herewith is a copy of application No. 1570 for a Cesspool/
Septic Tank Construction Permit submitted by:
William A. Forte
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.
tV)-1---yl,C.c-
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE /
4/
Cornments: e -' G- ..ei /0 'Z —0e;?
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Signature 7
OFFICE OF THE TOWN CLERK •,N'' ""''•.,,
Town of Southold 1 ' Of()Or Application No. / 6-70
Judith T. Terry, Town Clerk •• l/
Town Hall, 5305 Main Road •• .`` • 6 y-G
T. Construction
P. O. Box 1179 _ • - 4 'c
Southold, New York 11971 �tf� t_ 'h yc$' Alteration
Telephone • $10.00 - Residential
(516) 765-1801 1 * ��� ' $25.00 - Non-Residential
• �, . _ I
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No.
Fee .$ •
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DATE --kit/ / 7CiI
APPLICANT NAME: ZWill„¢d j 4. i—okerri
APPLICANT ADDRESS: ISP'
akS7 MI-3/48 (f La) N V . la 7o y
SEPTIC X CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Caw_ark Ltc i I 01‘) oF SIsi&c C /i ity
LOCATION MAP: • Must be attached hereto before permit may be issued.
LOCATION OF PRQMPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : tfilL,I¢-o41 4. • tere
OWNER MAILING ADDRESS: 6 f7 4aLit06r7o,tJ 7 b1 WF 3'144yL44
lt7ki
OWNER PROPERTY ADDRESS: //Sr 1-49i2Aart 4-NLS
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TELEPHONE NUMBER OF CONTACT PERSON : 576 -6.77—/7J"S—
TAX MAP NO. : Section c 4 7 Block � Lot /c . 3
CROSS STREET : Pr Qs-
BUILDING PERMIT NUMBER CROSS REFERENCE:
!tet
Signature of Applicant
RECEIVED BY : XV`/ / ,(.
Town Clerk's--Office
DATE:
r�U FOLK CO. HEALTH DEPT APl OV Iw:�.
i MOTE: LOT NISMBfiRS SHOWN& 12fi i? 'TO H.S. NO.
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to '� W TER SUPPLY AND SEWAGE DISPOSA►
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8 �, ���� t, 1 r. 412. �t { SERVICES - FOR APPROVAL 0 ti
7t II `• - - Ea ..1GHT - __.. �.; ,.... %._ 74, -____o / .1 1 CONSTRUCTION ONLY
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APPROVED:
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