HomeMy WebLinkAboutKing, Edward t,,I
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JUDITH T.TERRY �i°= y1 Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O
MARRIAGE OFFICER � Southold, New York 11971
Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER �l l �`i��1,,i 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. 1766 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EDWARD H. KING
Address 1 : 940 TUCKERS LANE
City St Zip SOUTHOLD NY 11971
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 #R10-97-0100
Name Of Owner KING, EDWARD AND CHERYL
Mailing Address 1 940 TUCKERS LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 TERRY COURT
City St Zip SOUTHOLD NY 11971
Tax Map No. section 69.00 block 3 lot 6.001
Cross Street CLOVER STREET
Building Permit Number Cross Reference:
Issue Date: 11/10/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
oFuLA„
JUDITH T.TERRY % y1 Town Hall, 53095 Main Roa
TOWN CLERK ; N i P.O. Box 1179
rr, $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER :=yijJ �� 1�' Fax(516) 765 1823
RECORDS MANAGEMENT OFFICER : '! 4 -0/ Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER •-.,„ .i",
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 31 , 1997 •
Transmitted herewith is a copy of application No. 1839 for a Cesspool/
Septic Tank Construction Permit submitted by:
Edward H. Kinq
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 reco mendations:
APPROVE
DISAPPROVE
Comments:
RECEIVED
NOV 10 1997
Signatu
Southold Town Clerk e 3 4
Dated
oU'1'14.[ VE l ||E 'TOWN CLERK
l',wn "| sooUo}/|
Judith l�. Tu,.y. Town Clerk
Application No./r3
[o~" Hall, 5]U9S Main Road ��--
constn
�~
|`. U. Dox 1179 • -' - -
South /N, New York 11971 Alteration
�.
Telephone • Residential.
( S|6) 76S- |801 `p�//rv�� �
' Non Residential. . __
• TOWN 0F 50t11.1101_11)
S0UT||OLU WASTEWATER DISPOSAL D|8T(1|CT
N`\'L|[/\T|0N
(o.
CONSTRUCT ION or ALTER ATION PERMIT
• 5 B`T |C lT A H K or CESSPOOL
•
Permit No.
'•
Fee $
-_�
DATE
--__-,_ ~--_-___--'__'_---_--_ -
7-
APPLICANT NAME:
EL,' . _
N `|]C/\N /\DDRESS: ^' - 4-77-•
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---_~_ -- ' _ ----'-----_-_____. -_-_-'---- -'_
- ----r' ------~-~- ~'-'---------------_--_' -
SEPTIC °� CESSPOOL w-
'--_' __-_-
NES(]R||`T ION OF PROPOSED CONSTRUCT ION OR /\|'TERA T|UN
/7 ^� '---------'---'---
��tin 0 67��,________�_________________
-'-_ -__--_`__-_----.----_-_----_-.
LOCATION MAP: Must be ai(ad`eJ hereto before permit may be Issued.
LOCATION OF PROPOSED CONST RUC TION OR /\LTERA[ ION:
OWNER OF PROPERTY :
OWNER MAILING K4/\|L|NC N)D|<ESS: f*^� ^�-~ '
--'--~-~~'�^==�==_-==c'--_____________._
-��
' __'._^-^_-__-__-_-
0YVNER PRO PERTY /\DURESS :
/ /
lELE|`||UNE NUMBER OF CONTACT P[H30N:
___( _-_-_'-_-_-^-~_^-�-'__--
TAX MAI' NO. : Section OC, 3__ __ Loi_ elp /~7-
CR0SSSTREET '
.--����-_--��
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|D/|L|)|NC PERMIT NUk413[|< CROSS REFERENCE : �~
•
• Signature )r Applicant
--------
RECEIVED
DATE : /
7�--------- '--'------- --
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� �� ' .' - ��� ' . �2�� `� _ _� � �
— SUFFOLK CO. HEALTH DEPT.APPROVAL '
` , • H.S. NO.
.4AP OF P20PEr rr Y
SUQ EP —
_ H, _0 CHERYL J. LING
`• •
f. � Wim/ j• ,.f.� COUNTY• DIPARTM ♦ OFHEALTH SeRVICES
COutv7Y, 1�l.Y POR 'APVWWAL OF comsTaucnori FOR A
FAMILY .E.,"t * ORLY
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Aiii , , App. •.,►:1, (Av, .-- N +/.\v�C.
f'., FOR M AXIKRI lii OF ammppms
3•• :, THREE YEARS FROM DATE OF APPROVAL
la
,r 4. Scale t 60 a t"
- 41 Area= 91, 149 aq.ff_
sh y' •
L'73,262 drxct.. r.o.vv)
A s tetOreu+s ►tf SUFFOLK CO. TAX MAP DESIGNATION:
DIST, SECT. BLOCK PCL.
' s �� 1000 069 3 6.1
-;14-; , OWNERS ADDRESS:
Tucers Lance
s' number's shown refer -to 'a
-" ` R` Subdivision 'nap treacle for
=' aEd. Y_ 11971
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