HomeMy WebLinkAboutMiller, Harry �o�OSfFO/
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JUDITH T.TERRY I _� ?<�� Town Hall, 53095 Main Road
TOWN CLERK ; y x P.O. Box 1179
I
REGISTRAR.OF VITAL STATISTICS tvO
MARRIAGE OFFICER
�`ifi �1$ Southold,New York 11971
Fax(516)765-1823
RECORDS MANAGEMENT OFFICER �1 * AY,
Y �1�� Telephone(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. 1531 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PETER SCHEMBRI
Address 1 : P. O. BOX 163
City St Zip WADING RIVER NY 11792
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-95-92
Name Of Owner MILLER, HARRY AND NORMA
Mailing Address 1 BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 LONGVIEW LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 5 lot 11 .000
Cross Street PLEASANT PLACE
Building Permit Number Cross Reference:
Issue Date: 8/27/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
, 1 000/iii ......... 5 3/
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JUDITH T.TERRY �i'_s Gym`� Town Hall, 53095 Main Road
C 1
TOWN CLERK % P.O. Box 1179
%REGISTRAR OF VITAL STATISTICS O rft $ Southold,New York 11971
MARRIAGE OFFICER `.yj.. .. . •g Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER =�1.( Jig -I.-,
I.- �I�i Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER n...„„ •S'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD , ---,,.,..,.,
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TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 22, 1996
Transmitted herewith is a copy of application No. 1597 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peter Schembri for Harry and Norma Miller .
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.
14-4--e4-
Linda
Lt%ec-
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following reeccommendations:
APPROVE 1/
DISAPPROVEri
(}
Comments:y494 (5-4 //C/v '5? 9
1/1110411
Sign- r- IF
Date:'
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OFFICE OF THE TOWN CLERK o_''""""'r--.,
Town of Southold ," F`7
Judith T. Terry, Town Clerk ' Application No.
Town Hail, 53095 Main Road e
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/4 : Construction
P. O. Box 1179 Alteration
Southold, New York 11971 ' k
Telephone = o'
$10.00 - Residential
(516) 765-1801411 ,,+` $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
0.?1,7"?/,
APPLICANT NAME: pv2-.— 5 c_ Ifsf
APPLICANT ADDRESS: Po P o K. L(a-5 (,J- t" R-1 �_`�� t l?
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTR TION OR ALTERATION:)il,e_j%
OWNER OF PROPERTY: iv / 4._ 141,44--0‘.
OWNER MAILING ADDRESS:
..5 = e •
OWNER PROPERTY ADDRESS: -UNG V'i--cv L .
Sau 0 .c
TELEPHONE NUMBER OF CONTACT PERSON: 7,2,
TAX MAP NO. : Sec ion Bloc Lot (/
CROSS STREET: •
BUILDING PERMIT NUMBER CROSS REFERENCE:
"0//
ignature of Applicant
RECEIVED BY: M
Town Office
DATE: c4
St!F FOLK CO_HEALTH DEPT a , y „
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