HomeMy WebLinkAboutRaffel, James c���
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JUDITH T.TERRY Z` Town Hall, 53095 Main Road
Jr TOWN CLERK y Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Vgl: i Southold, New York 11971
MARRIAGE OFFICER 44 �� Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER Ol `Nig t►a �.1' Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER o—.,,, ',,I���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1569 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JAMES B. RAFFEL
Address 1 : 195 LESLIE ROAD
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
ADDITION OF CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner RAFFEL, JAMES B.
Mailing Address 1 195 LESLIE ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 195 LESLIE ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 97.00 block 4 lot 15.000
Cross Street BAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 11/15/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
SZ
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JUDITH T.TERRY '�� 4 Town Hall, 53095 Main Road
r TOWN CLERK ; y = P.O. Box 1179
"7 $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `Dy Fax Fax (516) 765-1823
MARRIAGE OFFICER �Q a'." Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER _ 1 * ���
FREEDOM OF INFORMATION OFFICER '—..,„ ,o0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department 7
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: November 7, 1996
Transmitted herewith is a copy of application No. Al 635 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
lames Raffel (work by Ray Nine) .
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
•
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
RECEIVED
51996 • Addr--
,� e_
N01! 1Signatur: L f
"lan Cietit /!r
Date
4
OFFICE OF THE TOWN CLERK iso,
41..'
Town of Southold ���'��C,�� 01.1° •
Judith T. Terry, Town Clerk i%'' Cv4 Application No.� 35
Town Hall, 53095 Main Road Z 1 ; Construction
P. O. Box 1179 v T
Southold, New York 11971 stn yc,� Alteration �✓�
Telephone ...VA. ��ri $10.00 - Residential '—
(516) 765-1801 7- J � , ' $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 /tJc cr. — 7 — i g 9 W
APPLICANT NAME: 3ta-r-:-►e 3 . KIR ori
APPLICANT ADDRESS: 05- La€,-. Vim ,__
SEPTIC CESSPOOL ✓
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION A-DD o&r--
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : �_V?ft-,-r,G $, 9L/}rL
OWNER MAILING ADDRESS:__la 5 Lc I : -
OWNER PROPERTY ADDRESS: 5A-+-YnG.
—
TELEPHONE NUMBER OF CONTACT PERSON: i3 ./ — 7g7/ __
TAX MAP NO. : Section / Block Lot /T
CROSS STREET: /3-ei--/A . .
BUILDING PERMIT NUMBE CROSS REFERENCE:
Signature of A plicant --
RECEIVED BY :
1 Clerk's Office
DATE: — —
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