HomeMy WebLinkAboutKettenbeil, Laura � '. fFOL,1-
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JUDITH T.TERRY < Town Hall, 53095 Main Road
TOWN CLERK % N Z P.O. Box 1179
7 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER �y� ad Fax(516) 765-1823
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RECORDS MANAGEMENT OFFICER = � Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,,4S1�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1478 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LAURA & FRED KETTENBEIL
Address 1 : P. O. BOX 165
City St Zip PECONIC NY 11958
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. R19-96-0024
Name Of Owner KETTENBEIL, LAURA AND FRED
Mailing Address 1 P. O. BOX 165
City St Zip PECONIC NY 11958
Property Address 1 1155 LIGHTHOUSE ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 50.00 block 6 lot 5.010
Cross Street OLD NORT ROAD
Building Permit Number Cross Reference:
Issue Date: 5/16/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ` o= to, % Town Hall,53095 Main Road
TOWN CLERK d) Z % P.O. Box 1179
0 ,�� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �` ,f, O� '�1 Fax(516)765-1823
MARRIAGE OFFICER t1 Telephone(516)765-1800
RECORDS MANAGEMENT OFFICER �ai ,
FREEDOM OF INFORMATION OFFICER ..�,, •"'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 6, 1996
Transmitted herewith is a copy of application No. 1539 for a Cesspool/
Septic Tank Construction Permit submitted by:
Laura & Fred Kettenbeil
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: (.5-d, q/ o-
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TOWN OF SO,—�c'Lr. _._J
OFFICE OF THE TOWN CLERK ,,'",,"
Town of Southold ,�0" �FF14p,
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Judith T. Terry, Town Clerk „Os40 .
�� Application No./ 3y
Town Hall, 53095 Main Road Construction 26
P. O. Box 1179 /
Southold, New York 11971 t $ Alteration
Telephone _O.y rir $10.00 - Residential
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(516) 765-1801 � al 4' ,, ' $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 L4 f/
APPLICANT NAME: ° 1 V L
._.Q c9 r0. cT' -�r-QJ�L 1�e '�'�'2.i1 �7 Qf
APPLICANT ADDRESS: TO `�a7C /65
SEPTIC /CESSPOOL V
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: � �� 1�e V-en `oe\L
OWNER MAILING ADDRESS: ' O c x /6S
? c00LC— ,� y (KGs
OWNER PROPERTY ADDRESS: k.k 55 I-. .sL� .
hous- . Rock G
Soo-Ro kt .0y /ry 7
TELEPHONE NUMBER OF CONTACT PERSON:(S/6) 73V- 75cg--
TAX MAP NO. : Section QS 0 Block Lot 5, J0
CROSS STREET: p mac, r 1-0c,�
BUILDING PERMIT NUMBER CROSS REFERENCE:
e /6tiAiI _
Signature of Applicant
RECEIVED BY:,4/
owr ""r s0 ice
DATE: Nj / ��
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.4.- r SUFFOLK CO.HEALTH DEPT.APPRO 1
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TEST HOU-,'''
MSrc AolgSEWAGE DISPOSAL SYSTE MUST .:
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‘i WrnISUPPLYEY ANDvi STANDARDS DATED NOVEMBER13,199‘
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. AlR 2 1996
ROOERICK VANYL.P
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