HomeMy WebLinkAboutHagzan, Donna s
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JUDITH T.TERRY ',° y1 Town Hall, 53095 Main Road
TOWN CLERK y i P.O. Box 1179
`D4. y � ,,'�� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER : 4 asdi Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER iso
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1774 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN G GLEASON, ARCHITECT
Address 1 : 336 SIXTH AVENUE
City St Zip ST. JAMES NY 11780
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 #R10-94-0018 (EXTENDED TILL 3-11-00)
Name Of Owner HAGZAN, DONNA
Mailing Address 1 81 WASHINGTON AVENUE
City St Zip KINGS PARK NY 0000
Property Address 1 ALVAH'S LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 101 .00 block 1 lot 16.007
Cross Street COUNTY ROAD 48
Building Permit Number Cross Reference:
Issue Date: 11/24/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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f n R m E o ,�`�O�pS�FFO(,��oG,` / 77K
JUDITH T�' RRY 9 0 +�� yr4% Town Hall, 53095 Main Road
TOWN CORK'' ��"' _ P.O. Box 1179
�i' Southold, New York 11971
REGISTRAR OF VITAL EPT p ,
MARRIAGE OFFI :'y 0-111 Fax(516) 765-1823
C 'N OF SOUTHOLD �Ql �* 11 Telephone(516) 765-1800
RECORDS MANAGE' - ..jr. to
FREEDOM OF INFORMATION OFFICER .„„ ,1•4
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 20, 1997
Transmitted herewith is a copy of application No. 1848 for a Cesspool/
Septic Tank Construction Permit submitted by:
Donna Hagzan .
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
DISAPPROVE
Comments:
,,.
Signat rt
Dated
OFFICE OF THE TOWN CLERK ,,,,,,,,••-
Town of Southold •,� Wire
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Judith T. Terry, Town Clerk ;'',% OGS Application No. �� 7�
Town Hall, 53095 Main Road
P. O. Box 1179 - ; Construction
Southold, New York 11971 tfl
Alteration
�- ; $10.00 - Residential
Telephone O �`-
(516) 765-1801 � .���,��
•
$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 / 4 7
APPLICANT NAME: /)A iNd i�tU
APPLICANT ADDRESS: �,./ �d9�.✓ �,/ ��� `L//
� N
SEPTIC Doc, CESSPOOL a`
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
_J��• •sN'-- ,. 7'��11 J f - i „ " size' rc4, i'�
// 6L. A /.7� J am, e l . . s'I
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 1:DG7
OWNER MAILING ADDRESS: 2,A �� Ave
N..... P IS
OWNER PROPERTY ADDRESS: S
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /f Block
/ Lot /o ,
CROSS STREET: M/r. eie
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signatu of Applicant •
RECEIVED BY:
o n I rk's j Office
DATE: 'L
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r0; JOHN G. GLEA , , i I C't'
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DATE: 7/16/97 SCALE: 14 64V . SHJET 1 of 1
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