HomeMy WebLinkAboutMoeck, Stephen (2) OFFOLAe
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JUDITH T.TERRY tt = yl Town Hall, 53095 Main Road
TOWN CLERK % N = P.O. Box 1179
v- 'r �1 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER V4 ��0.1�, Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER O1 .�►`���� Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER i'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1523 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : STEPHEN MOECK
Address 1 : 1525 AQUAVIEW AVENUE
City St Zip EAST MARION NY 11939
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. #R10-96-0033
Name Of Owner MOECK, STEPHEN
Mailing Address 1 1525 AQUAVIEW AVENUE
City St Zip EAST MARION NY 11939
Property Address 1 OLD FARM ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 25.00 block 5 lot 11 .000
Cross Street KING STREET
Building Permit Number Cross Reference:
Issue Date: 8/12/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY % o .: Town Hall, 53095 Main Road
TOWN CLERK % H = % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER y2, 'W # Southold,New York 11971
0- oil
Fax(516)765-1823
RECORDS MANAGEMENT OFFICER °.( * `T►ai,l• Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER .-. i00
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 5, 1996
Transmitted herewith is a copy of application No. 1589 for a Cesspool/
Septic Tank Construction Permit submitted by:
Stephen Moeck -
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
J� (77.e/i.,(<1(/0- 4-0
�
Comments: Q���-Of, 1�-�-r7 �i' 7 /�1o�- i-O 3
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Signat e,-/ y /}
Dated .
OFFICE,OF tHE TOWN CLERK
,Town of Southold °'ctFtk
Judith T. Terry, Town Clerk ,' Application No./58
Town Hall, 53095 Main Road .CL:
Construction `--
P. 0. Box 1179
Southold, New York 11971 • Alteration
Telephone = �f $10.00 - Residential '"'--
(516) 765-1801 > $�, +'` $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 //vi S' r7 C
APPLICANT NAME: 7--t-7°/-71y l4✓]0GLC
APPLICANT ADDRESS: /,52S A(d1J4 t//L J , 'E
/o ,.) /l/y //93S
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Prrc 5Y5ryo Fo4' 4/..gu/ /AIa.5 F'
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: S /12 OCk-
OWNER MAILING ADDRESS: /r4 - 4QU/4✓i/2-- i 1
5, / 7.*1 /dal by / fQ39
OWNER PROPERTY ADDRESS: 0// fc? rn del Qv,ei
TELEPHONE NUMBER OF CONTACT PERSON: 'V '7 — SW -7
TAX MAP NO. : Section 02 5 Block S Lot //
CROSS STREET: 56
BUILDING PERMIT NUMBER CROSS REFERENCE:
/ x'7 '7
gnature of Applicant
RECEIVED BY: (/Lhui4L__
Tbwn Clerk's Office
DATE: O/ / 96
a.�� 1 /_ '"` (5) r . �-f i SUFFOLK CO. HEALTH DEPT. vii
�'• t0.�� 1 11> yi — 11i♦.,. I H. S. NO.
1)(''''C‘)
. iy•,.`+\ +ems# ♦.
$ o SUPPLY AND SEWAGE DISPOSAL SYSTEMS MUST _ .--. MAY `
CUt*ORM Wmi NEW STAND
t ,
i' AADS DATED NOVVIIIrt1t 13,1995. •••, - , ✓ i •" ..1 r' _ t i ` j
\` ‘13,�3 '/ \` t . � f S.C. DEPS. OF ' ,-�
\ "4 i _. .r;•� , L'. :_LI_.__•_s�- NEALIH SERVII , I :
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9. \ '� I ! 1. 1 N r.7"— STATEMENT OF INTENT '�``-
�/�IME TOFSEALTHSIdtWCES �- -,---- - �1 `- c t-% i _L THE WATER SUPPLY AND SEWAGE DISPOS
5UFPOLKG , - --- -- .-_-- _ f SYSTEMS FOR THIS RESIDENCE �Ilf{� t;;
pziouT lOA A> OVAtaO)R CpN$CAUC�O>K A d
CONFORM TO THE STANDARDS OF THE
SI NGLI FAMILY WM « ' Y
13.. E J- +;Ci +-
SUFFOLK CO. DEPT. OF HEALTH SERVE
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DATE i/ �f� ✓ .� APPLICANT
AppROvED • , i /,".k.... t C' in11.4 OV .,0i.1�7.HO L.d, Y `
�' o/ I SUFFOLK COUNTY DEPT. OF HEA1.Th
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� CONSTRUCTION ONLY '
4 •-, l ;, .., s DATE:
EF.NO.:
APPROVED:
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