HomeMy WebLinkAboutNicholson, Frank SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1516 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : FRAND ED NICHOLSON
Address 1 : 8 SYLVAN ROAD
City St Zip ROCKY POINT NY 11778
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. #R10-96-0067
Name Of Owner NICHOLSON, FRANK ED
Mailing Address 1 8 SYLVAN ROAD
City St Zip ROCKY POINT NY 11778
Property Address 1 1250 EVERGREEN DRIVE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 1 lot 4.011
Cross Street DEPOT LANE
Building Permit Number Cross Reference:
Issue Date: 8/06/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•Sao (k FOL, ;
JUDITH T.TERRY �I o y1 Town Hall, 53095 Main Road
TOWN CLERK % N = % P.O. Box 1179
v. �� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS %0 "V" Fax (516) 765-1823
MARRIAGE OFFICER �;�j01 ��0'�/ Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER - J�L 1,��
FREEDOM OF INFORMATION OFFICER .••�
1r "t
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD JUL / 6 l99
GLEN.DL 'T.
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 26, 1996
Transmitted herewith is a copy of application No. 1581 for a Cesspool/
Septic Tank Construction Permit submitted by:
Frank Ed Nicholson •
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 ‘.7
DISAPPROVE
Comments: l9.21.2./1/— Qc' ,e.g/ J Se- 77.‘ 4 30' r00 67
oAril i.."
Signature
6:/. -- 6
Dated
/57k
OFFICE OF THE TOWN CLERK
o,
' •
Town of Southold •. ���OLK t
Judith T. Terr �� Application No! 615-1
y Town Clerk I P t
Town Hall, 53095 Main Road �i `
Construction
P. 0. Box 1179 ; � --
Southold, New York 11971 : Cf i� � Alteration
•
Telephone '- � a�Q•�.,��� $10.00 - Residential
(516) 765-1801 �{�
Ol �v 1� $25.00 - Non-Residential
4°0 . /Ll
TOWN OF SOUTIIOLD
SOUTIIOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE —26D--��p
APPLICANT NAME: .12Ar\� /JiChoL5o,J
APPLICANT ADDRESS: n1
•`g 5 L-UiA
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
r Fes) S FA m i Ly 16 W LLJ N
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PRQ,,POSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY : cRAn� AJ lcri i .
OWNER MAILING ADDRESS; _ 5yLUMJ Rac)
gp
�� N9
OWNER PROPERTY ADDRESS: L250 eligIZG4Z.EkAi
C. 0.7cli6Z-il.E-
TELEPHONE NUMBER OF CONTACT PERSON :'5) 1)44
TAX MAP NO. : Section 16Z. Block ` Lot 4 • \\
CROSS STREET : i)E-P.;:).7
BUILDING PERMIT NUMBER CROSS REFERENCE: _
ft:tilA-6401Signature of Applicant
RECEIVED B Y : RECEIVED
j6ewg 6 lf0 s Office
DATE;
fowl Clerk Southold — -
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c t� �� NOTES: c SYLVAN W.
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