HomeMy WebLinkAboutKoch, Barbara ilgUFFO117o
ELIZABETH A.NEVILLE $�`t� Gym'` Town Hall, 53095 Main Road
TOWN CLERK CO3 _-� , P.O. Box 1179
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Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %%•% •� Fax (516) 765-1823
MARRIAGE OFFICER 4,
RECORDS MANAGEMENT OFFICER : �49! � S ��� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER //01��so
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1870 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : CURT KOCH
Address 1 : 185 SOUTHERN BLVD.
City St Zip HAUPPAUGE NY 11788
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 #R10-97-0162
Name Of Owner KOCH, BARBARA
Mailing Address 1 185 SOUTHERN BLVD.
City St Zip HAUPPAUGE NY 11788
Property Address 1 NASSAU POINT ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 111 .00 block 12 lot 5.004
Cross Street WUNNEWETA ROAD
Building Permit Number Cross Reference:
Issue Date: 6/03/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE 1• *INTown Hall, 53095 Main Road
TOWN CLERK p -� 2. 7 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
't Fax (516) 765-1823
MARRIAGE OFFICER Oy v�
RECORDS MANAGEMENT OFFICER .70l 4 .a0 lei
�� Telephone (516) 765-1800
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 26, 1998
Transmitted herewith is a copy of application No. 1944 for a Cesspool/
Septic Tank Construction Permit submitted by:
Curt Koch for Barbara Koch
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:
�Signatu
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Dated
OFFICE OF TI1E IOWN CLERK c31FGi ' ""
Town or, Southold C�. t Application No. / 7
/f/
Judith T. Terry, Town Clerk
Town Ilall, 53095 Main Road ` Construction — "
P. O. Box 1179
Southold, New York 11971 ,y, *"/ Alteration_ --
Telephone Oli ��O �° Residential•
(516) 765-1801
Non-Resider tial
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ Q
DATE � g9tl
APPLICANT NAME: (_ v,- fi /4)
APPLICANT ADDRESS: /8s ,/tze iyikd
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SEPTIC V CESSPOOL ✓
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION______
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LOCATION MAP: Must be attached hereto before permit may be issued.
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LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: /4-ss/ty f1g,, 1 /p&T.
OWNER OF PROPERTY : & r 6&-& e"<4.
OWNER MAILING ADDRESS: /gs Sn✓ftp t gfv-C
OWNER PROPERTY ADDRESS: /V4 %-• T
TELEPHONE NUMBER OF CONTACT PERSON: 516 A 33 657 '/ s/616SJ- Z‘ e/
TAX MAP NO. : Section /1/ t3lock / 2- Lot •S---, 11(
CROSS STREET : I /fro,T4 d� Gigilh 24/64 k "d 320 i ..
BUILDING PERMIT NUMBER CROSS REFERENCE:
- - Signati.ire of Applicant -
RECEIVED BY : / ,/ ! ---
Town c's Office
DATE:
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" SUFFOLK COUNTY DBPARMEW OF HEALTH SERVICES
PZR UT FOR APPINOIVAL OIT CourtiwcrioN POR A
FAMILY INIMINKCE ONLY
DATE
ri�/zREF.tiro F10, q� - o�6�,
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APPROVED ,_�•
POR MAADAUM or_"BEDROOMS
EXPIRES THREE YEARS FROM DATE OP APPROVAL
UNATHORIZED ALTERATION OR ADDITION
TO THIS SURVEY IS A VIOLATION OF
SECTION 7200 OF THE NEW YORK STATE
EDUCATION LAW.
COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYOR'S PIKED SEAL OR
EMBOSSED SEAL SHALL NOT SE CONSIDERED
TO BE A VALID TRUE COPY.
CERTIFICATIONS INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED, AND ON HIS BEHALF TO THE
TIRE COMPANY, COMMIX/MIL MIENCY AND
LENDING INSTTWUON USTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI-
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE
THE EXISTANCE OF RIGHT OF WAYS
AND/OR EASEMENTS OF RECORD, IF
ANY, NOT SHOWN ARE NOT GUARANTEED.
PREPARED IN ACCORDANCE WITH THE MINIMUM
TITLEST FOR SURVEYSJoseph A. Ingegno
�.r AND APPROVED AND ADOPTED
.i�� � �iS'�� ; •THE NEW YORK STATE LAND
G Land Surveyor
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°y'^ Title Surveys — Subdivisions — Site Pbns — Construction LmAx.
•9� . , ,9 'f' PHONE (516)727-2090 Fax (516)722-509
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