HomeMy WebLinkAboutFriedberg, M Paul (2) iii�•-
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JUDITH T.TERRY tt��/P yL�• Town Hall, 53095 Main Road
TOWN CLERK y 2 P.O. Box 1179
• Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER :`yifJ 0� 1�' Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER :;An
iNg �►��d 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. 1491 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 A NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-06-0048
Name Of Owner FRIEDBERG, M. PAUL
Mailing Address 1 1000 SPRINGS FIREPLACE ROAD
City St Zip EAST HAMPTON NY 11937
Property Address 1 SELAH LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 9 lot 4.008
Cross Street COX NECK LANE
Building Permit Number Cross Reference:
Issue Date: 6/11/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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IoStFFo,,�co
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JUDITH T.TERRY X01�g yt Town Hall, 53095 Main Road
TOWN CLERK N i P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
Southold,New York 11971
MARRIAGE OFFICER yi 0�111
a ' Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER �l '1►�i,,' Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ••1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD `- ' '
TO: Southold Town Building Department M f r
TOWN. ;F cFsCLO
FROM: Linda J. Cooper, Southold Town Clerk's Office j - -------w
DATED: June 5, 1996
Transmitted herewith is a copy of application No. 1556 for a Cesspool/
Septic Tank Construction Permit submitted by:
Gendot Associates 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
Corn me nts:
�eg/471/:617--.9rac4")
Signature
Dated
OFFICE OF 1HE TOWN CLERK ,,,""""••.,
Town of Southold 01" ,F ULif e .
Judith T. Terry, Town Clerk �` �Q.0 (VIA Application No. A5-7
Town Hall, 53095 Main Road ��
� Construction L./P. 0. Box 1179 --
` Al
Southold, New York 11971
c:=1
� Alteration
'�
Telephone O,y� �Q ' $10.00 - Residential
(516) 765-1801 Ol * ,, ' $25.00 - Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT.
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATER.,,z-ru.e--) p ji /5W
APPLICANT NAME: A/1.04)/...--t.
APPLICANT ADDRESS: re 517
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
- -
, >/
,>''
LOCATION M • • Must be attach-d hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: �,
OWNER MAILING ADDRESS: /.0•11-e 14f . ate
• • / - ' /19 7
OWNER PROPERTY ADDRESS: „--de-eek.44 .
TELEPHONE NUMBER OF CONTACT PERSON: 9 3/g
TAX MAP NO. : Section /D to Block (� 9 Lot 4 'r
CROSS STREET: t!d
BUILDING PERMIT NUMBER CROSS REFERENCE:
,
ature of Applicant
RECEIVED BY: 'z
own Clerk's Office
DATE: /►''p �
�
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