HomeMy WebLinkAboutFoster, Artie 4?
Town Hall, 53095 Main Road
14
Q 0- f P.O. Box 1179
" i"10/ $s$1)_ Southold, New York 11971
JUDITH T.TERRY �• TELEPHONE
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. 1708 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : RAY DICKHOFF
Address 1 : P. O. BOX 696
City St Zip AQUEBOGUE NY 11931
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 #R10-97-0114
Name Of Owner FOSTER, ARTIE
Mailing Address 1 P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935
Property Address 1 ELIJAH LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 108.00 block 4 lot 7.014
Cross Street TABOR ROAD
Building Permit Number Cross Reference:
Issue Date: 7/31/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
0-'fill;k11fF0��-�oG .
JUDITH T.TERRY tI_� t.N Town Hall, 53095 Main Road
TOWN CLERK % C2. P.O. Box 1179
CO3 Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V tO *- Fax (516) 765-1823
MARRIAGE OFFICER .tLy�� �O.11� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER 1 - ,1
FREEDOM OF INFORMATION OFFICER .sol
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
0
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 29, 1997
Transmitted herewith is a copy of application No. 1777 for a Cesspool/
Septic Tank Construction Permit submitted by:
Ray Dickhoff for Artie Foster
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 rec mendations:
APPROVE
DISAPPROVE
Comments:
S' 446-A--4—E
nat
Dated
OFFICE OF THE TOWN CLERK ,l,''F01
Town of Southold 1'','��F KL'OGy_' Application No. !� `7`7
Judith T. Terry, Town Clerk Town Hall, 53095 Main Road = Construction v^
P. O. Box 1179
Southold, New York 11971 � Alteration
Telephone ,yy �� �; $10.00 - Residential
(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 $
DATE127/77 _ __----____--
APPLICANT NAME: 1/ f1/l��j/Oi/:APPLICANT ADDRESS: A ,dOJI9J% "4Quf Z4 1/L
/U`, /1i1._ �/
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
? fele /3'9/4/ 1 %v_c.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 19'e//£ S'ifX
OWNER MAILING ADDRESS: /O ,( O/I( //r,� `.
c7F
OWNER PROPERTY ADDRESS: F1/ /T//!.!//�`e/e
TELEPHONE NUMBER OF CONTACT PERSON:_
TAX MAP NO. : Section MO Block 26 k Lot eq—
CROSS
q'CROSS STREET : _FQ
BUILDING PERMIT NUMBER CROSS REFERENCE:
- cE ei� —
ignatu f Applicant
RECEIVED BY :
Town Clerk's Office
DATE: "' %
t
'a' /.m1N► ufim M. STANDARDS FOR APPROVAL JUL 17 1997 ,
A!� CONSTRUCTION OF S FACE SEMAGE `� N �^ 91/okE aapta
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and will perm@ I. c.a.avc. F� SURVEY Of
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