HomeMy WebLinkAboutGlew, Michael 100
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ELIZABETH A.NEVILLE •h`Z(\ Town Hall, 53095 Main Road
TOWN CLERK
P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax Fax (516) 765-1823
MARRIAGE OFFICER y
RECORDS MANAGEMENT OFFICER -_1101 * 40 $�� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ���
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1839 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MICHAEL AND CLAIRE CLEW
Address 1 : P. O. BOX 188
City St Zip ORIENT NY 11957
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 #R10-98-0015
Name Of Owner CLEW, MICHAEL AND CLAIRE
Mailing Address 1 P. O. BOX 188
City St Zip ORIENT NY 11957
Property Address 1 1805 MILL PATH
City St Zip SOUTHOLD NY 11971
Tax Map No. section 56.00 block 1 lot 4.003
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 4/10/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE i.�`t� �t; Town Hall, 53095 Main Road
TOWN CLERK ; p :— P.O. Box 1179
Cl) Z . Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘ Fax Fax (516) 765-1823
MARRIAGE OFFICER �` * 1
RECORDS MANAGEMENT OFFICER ....:70.1 �I X 11
S 111 Telephone(516) 765 1800
FREEDOM OF INFORMATION OFFICER
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p 1UO \Y1E
OFFICE OF THE TOWN CLERK _
TOWN OF SOUTHOLD " 2 ti . . „
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BLDG.DEPT.
TO: Southold Town Building Department TOWN OF SOUTHOLD '
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 2, 1998
Transmitted herewith is a copy of application No. 1913 for a Cesspool/
Septic Tank Construction Permit submitted by:
Claire and Michael Glew .
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.
,.._‘, 4z
Linda J. Cooper r
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recom ndations:
APPROVE
DISAPPROVE
Comments:
ignatu
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113/9 9i e
Dated
,S .....
OFFICE OF THE TOWN CLERK 0c.OF 1Lf D
Town of Southold .. CG cy
Judith T. Terry, Town Clerk Application No./ /!
Town Hall, 53095 Main Roadc ;;;. Construction
P. O. Box 1179 .
Southold, New York 11971 O �. ` Alteration
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Tele hone 'z1 H* �� • Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 07q b
APPLICANT NAME: kik ( (Ade ( 4- C [alre (;(eAt1/4)
APPLICANT ADDRESS: p U b oc i
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
( C.- - 4 "`fie-e a0 ( S
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALT ATI N:CTIONOWNER OF PROPERTY: C GC (r e LC g
OWNER MAILING ADDRESS: d ,E)l)
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yv,
OWNER PROPERTY ADDRESS: 1 OO5 14( a {-)
_, Loci ivLitI
TELEPHONE NUMBER OF CONTACT PERSON: ,*j a-3 -Q
TAX MAP NO. : Section5(p Block / Lot Li ,3 .
CROSS STREET: 1121alo f.C1
BUILDING PERMIT NUMBER CROSS REFERENCE:.
rya(.(_,
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Signature of Applic nt
RECEIVED BY: -VU
/)--A--S
i0-- Town Clerk's Office
DATE:
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ti d M PLEASE NOTE ° /vie,edvrov+`v .98 soe.87 ri 1. 11
Minimum
m distanc1
distanceA �
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and cesspool
well 27 ,�� � `1"c, 1 �.
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o be 150.feet.
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O I gF v r.i,3'Mr J FOR SANITARY SYSTEM
V� r- '^� ` GaavrJpr \
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t ".v. "'ej $4o/vSar '"e-4- 'a`"wr /V•y
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Sanitary system is notle 2.144141w
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iiii .crf� placed under driveway areaa..
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