HomeMy WebLinkAboutFriedberg, M Paul ie" „
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JUDITH T.TERRY ��_ yl Town Hall, 53095 Main Road
TOWN CLERK y = P.O. Box 1179
$ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS \-°;*
y ����� Fax (516) ?65-1823
RECORDS MANAGEMENT OFFICER
MARRIAGE OFFICER � �f�1 a���i� Telephone (516) 765-1800
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FREEDOM OF INFORMATION OFFICER ,,00
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1454 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GENDOT ASSOCIATES, INC.
Address 1 : P. O. BOX 847
City St Zip WADING RIVER NY 11792
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-06-0018
Name Of Owner FRIEDBERG, M. PAUL
Mailing Address 1 1000 SPRINGS FIREPLACE ROAD
City St Zip EAST HAMPTON NY 11937
Property Address 1 165 SELAH LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 9 lot 4.004
Cross Street COX NECK LANE
Building Permit Number Cross Reference:
Issue Date: 4/09/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ; C c % Town Hall, 53095 Main Road
TOWN CLERK t cf _ 1 P.O.Box 1179
REGISTRAR OF VITAL STATISTICS 0 Southold,New York 11971`
MARRIAGE OFFICER :4,,, 0' Fax(516)765-1823
RECORDS MANAGEMENT OFFICER -- of , `1►a,, Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER . . o'
OFFICE OF THE TOWN CLERK 5 1996
TOWN OF SOUTHOLD F',
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 22, 1996
Transmitted herewith is a copy of application No. 1513 for a Cesspool/
Septic Tank Construction Permit submitted by:
GenDot Associates Inc. for M. Paul Friedberg •
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 ����
Comments: ,Jv, „2324,7, c C7�`t(� ?xi/ Jeo 96
RECEIVED
APR 9 1996 Adir/AF•ii/C/a/Mr;li
Sian.ur
Town Clerk Southold 96
Dated
*-
OFFICE OF THE TOWN CLERK ,,,,"'•
•
Town of Southold ssol fete e; .
Judith T. Terry, Town Clerk �. G Application No.� �
Town Hall, 53095 Main Road �� �` Construction
P. O. Box 1179
• 4 ' Alteration
Southold, New York 11971 %VI yc$
Telephone ��°,y Q�,�'� $10.00 - Residential
(516) 765-1801 t
• • • oga $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE --3A- 6) /! k
APPLICANT NAME: j1z2/ QdGa
� C�J
APPLICANT ADDRESS: ,P- &"") J97
1v, X //79g—.
SEPTIC t/CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
—
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : /17, P� i'i.. Fie
OWNER MAILING ADDRESS: /G -6 /i - 4
OWNER PROPERTY ADDRESS: oZ,-- *' a.— 77- r L
`ja-4 L4u
TELEPHONE NUMBER OF CONTACT PERSON: /73/j
TAX MAP NO. : Section /d 4, Block 9 Lot 'j�, I
CROSS STREET: L" I' )14.1.4../
c .�
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignature of Applicant
RECEIVED BY BYRECIEnne5.v)
own Jerk's ffice
DATE: MAR 22 996
Torn Clerk Sovthoid
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