HomeMy WebLinkAboutHouser, A Madeline •
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JUDITH T.TERRYyl • Town Hall, 53095 Main Road
TOWN CLERK ; N Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O
�� Southold, New York 11971
MARRIAGE OFFICER : 4k 0. /0
Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER �! * -0„09 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER —..,„ go"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1507 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : LOSCHE, ROBERT AND LORRAINE
Address 1 : 5 BASKET ALNE
City St Zip HICKSVILLE NY 11801
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner HOUSER, A. MADELINE
Mailing Address 1 C/O LORRAINE LOSCHE
5 BASKET LANE
City St Zip HICKSVILLE NY 11801
Property Address 1 1200 STROHSON ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 10 lot 26.000
Cross Street BALDWIN PLACE
Building Permit Number Cross Reference:
Issue Date: 7/15/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY ��I� y�.t Town Hall, 53095 Main Road
TOWN CLERK y Z P.O. Box 1179
t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS % O I%
MARRIAGE OFFICER
9* Fax Fax (516) 765-1823
�
RECORDS MANAGEMENT OFFICER O! O �ilig 4',,,6 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,•�"6�
_
OFFICE OF THE TOWN CLERK ;i `;�
; ir
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 11, 1996 .-..-`
,,rrJJ /� J
Transmitted herewith is a copy of application No. A1572 for a Ces ool/
ion Permit submitted by: /`,,
Chris Rehm for Robert & Lorraine Losche -
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: y 1 13i ..,- ...7(.:;
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Signature /
Dated .
OFFICE OF THE TOWN CLERK ,as"l
Town of Southold 1,cJ\\ ►
VOL/( � �� `7
�G Application No.
Judith T. Terry, Town Clerk ;0 ( y
Town Hall, 53095 Main Road z�. Construction_
P. O. Box 1179 : v rn ; Alteration —4–/-----
Southold, New York 11971 ;� 4 , �-
Tele hone
c.-----
‘7%.‘l& s0"" $10.00 - Residential
Telephone � �
(516) 765-1801 $25.00$25.00 - Non-Residential
--- .. , II,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
,
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
-----__---_--- DATE ,L ,,144,01 / 7
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APPLICANT NAME: i 4 ,eit _/
APPLICANT ADDRESS:_ Xace...'
—� -77T //So /
SEPTIC CESSPOOL ,
DESCRI TION OF PROPOSED CONSTRUCTION OR ALTERATION / D A
si
L, _, SSA'c/ _____
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST UCTION OR ALTERA ION:
OWNER OF PROPERTY : U.%-,Oticitir-l;/ce
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OWNER MAILING ADDRESS: 57sizt2;/_____ ______/th .
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OWNER PROPERTY ADDRESS: / c.POO /�T��-/ L
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7,5 - -/-6�k7( -'
TELEPHONE NUMBER OF CONTACT PERSON:4 5-7(0) G `Y-45 CI /. )
TAX MAP NO. : Section /03 Block D Lot
kP3 WI
CROSS STREET: ,O4 -D cv/A..) q--
BUILDING PERMIT NUMBER CROSS REFERENCE:
____ MAVAI ,i) 411.e-4AL,
Signature of Applicant
RECEIVED BY: , a)A-10/
own Clerk's Office
DATE: --) ( i/ - 6
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