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JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK y 2 i P.O. Box 1179
1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS % **Oy � ,��� Fax(516) 765-1823
MARRIAGE OFFICER ; �lJ� `11. Telephone (516) 765-1800
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RECORDS MANAGEMENT OFFICER 1
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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. 1656 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN A. PRIZEMAN
Address 1 : 131 HICKS STREET
City St Zip BROOKLYN NY 11201
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. SCHD REF. #R10-97-0077
Name Of Owner PRIZEMAN, JOHN A.
Mailing Address 1 131 HICKS STREET
City St Zip BROOKLYN NY 11201
Property Address 1 ROCKY POINT ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 21 .00 block 4 lot 13.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 5/12/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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APR 2 5 1997 ,
• B > Town Hall, 53095 Main Road
— ----- i e P.O. Box 1179
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T(' LP9 OF 50 '.4 ! 1s�� 4 b Southold, New York 11971
JUDITH T.TERRY �., TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DA IVD: April 25, 1997
Transmitted herewith is a copy of application No. 1735 for a Cesspool/
Septic Tank Construction Permit submitted by:
John A. Prizeman
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:
RECEIVED
MAY 8 1997
Sou ::::t
thold Town Clerkc•Pi://797
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(/F|'|CE OF HIE TOWN CLERK
Town o| Southold
Ac-'
Application
pp|ica(ioo No' / �� /-.....)Judith T. Terry, Town Clerk
[own ||aU 53095 Main Road
' Const ruction _
P. 0.
Box 1179 -- �~-
Souihn|d. New York 1l97l � Alteration
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Te|ephone Residential /'�
( 516) 765-1801 `---?: a '
Non-Residential
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TOWN 0FSOUTUOLD
SOUT||OLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
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for
CONSTRUCT ION or ALTERATION PERMIT
SEPT IC TANK or CESSPOOL
Permit No.
Fee $__________
DATE 2 is- 7
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APPLICANT NA&iE : »� K��
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APPLICANT ADDRESS: / ~~
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SEPT|C CESSPOOL
DESCRI PT ION OF PROPOSED CONSTRUCT ION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY : goAP
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OWNER MAILING ADDRESS: /3/
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0YVNER PROPERTY ADDRESS :
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TELEPHONE NUMBER OF CONTACT PERSON : ^�� ��
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CROSS STREET : -2.5"4. .
BUILDING PERMIT NUMBER CROSS REFERENCE :
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