HomeMy WebLinkAboutMartz, Theodore (3) i•of),
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ELIZABETH A.NEVILLE 1,•=`Z�� �Gy1; Town Hall, 53095 Main Road
TOWN CLERK , p P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICStvir
MARRIAGE OFFICER Oy ��,� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER
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(516) 765-1800
FREEDOM OF INFORMATION OFFICER �c "I
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1813 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JODI A. BENNETT
Address 1 : 1029 WILLIAM FLOYD PARKWAY
City St Zip SHIRLEY NY 11967
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 #R10-98-0017
Name Of Owner MARTZ, TED
Mailing Address 1 145 RYERSON AVENYUE
City St Zip MANORVILLE NY 11949
Property Address 1 STANLEY ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 8 lot 9.000
Cross Street DOGWOOD LANE
Building Permit Number Cross Reference:
Issue Date: 2/23/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE 'e Gy Town Hall, 53095 Main Road
TOWN CLERK arc P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICERv
RECORDS MANAGEMENT OFFICER ��y� O� Telephone(516) 765-1800
6:1FREEDOM OF INFORMATION OFFICER ill's
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Buildina Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 13, 1998
Transmitted herewith is a copy of application No. 1887 for a Cesspool/
Septic Tank Construction Permit submitted by:
Jodi Bennett. for Ted Martz
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 endations:
APPROVE
DISAPPROVE
Comments:
. Lexi
ignature
Dated
OFFICE OF THE TOWN CLERKVF FQ ' _ -7
TOWN OF SOUTHOLD �C� Application No. / /
ELIZABETH A.NEVILLE,TOWN CLERK10.00 - Residential
P.O.BOX 1179 M $
SOUTHOLD,NEW YORK 11971 $25.00 - Non-Residential
Telephone -71 ill Of
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
GD/ySTeu c-r-7(
MN PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
PpLi c Nr hod --pe r� -
DATE e
OWNER NAME: 7E0 /y)lei-,'r a-
OWNER MAILING ADDRESS: NS /eL i or.) I"(1€,
(LL& ,-)y
OWNER PROPERTY ADDRESS: ,S;e%r7lZ-
OWNER TELEPHONE NUMBER: U " i3 81/V3
TAX MAP NO. : Section /ll 6 Block Q 8 Lot
CROSS STREET: _5/p/Li.' La 1Pa 6-0 cop L
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New ;/ Existing
Residential i Non-Residential
6(-) sLOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Aft • It
-ignature • • pp icant
RECEIVED BY:
Town Clerk's Office
DATE:
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