HomeMy WebLinkAboutSchulz Dex Cor[ ` 1 ho'OSUFFO�
ELIZABETH A.NEVILLE �`Z` y • Town Hall, 53095 Main Road
TOWN CLERK % p 1 P.O. Box 1179
ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS • v'
Fax (516) 765-1823
MARRIAGE OFFICER L
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RECORDS MANAGEMENT OFFICER ��Q� � Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ����� -
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1807 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN KAYWOOD
Address 1 : 1410 MIDDLE COUTRY ROAD
City St Zip CENTEREACH NY 11720
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. REF #R10-97-0180
Name Of Owner SCHULZ DEX CORP
Mailing Address 1 49 CORAM MT. SINAI RD.
City St Zip CORAM NY 0000
Property Address 1 BREAKWATER ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 9 lot 7.005
Cross Street MILL ROAD
Building Permit Number Cross Reference:
Issue Date: 2/11/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH
ELIZABETH A.NEVII.LE
%. Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK o
y Z Southold,New York 11971
Pry
REGISTRAR OF VITAL STATISTICS 0 Fax Fax (516) 765-1823
MARRIAGE OFFICER %. 1�acS ," Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 9, 1998
Transmitted herewith is a copy of application No. 1881 for a Cesspool/
Septic Tank Construction Permit submitted by:
John Kaywood for Schultz Dex Corp
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:
Si ature
I 5c
Dated
1
OFFICE OF' THE TOWN CLERK
Town of Southold IIApOvation No. 1 Cs--.8"/
Judith T. Terry, Town Clerk
Town Hall, 5305 Main Road w Construction v _
P. O. BO* 1179
Alteration
Southold, New York 11971
Tele one $10.00 -Residential
(516) 765-1801 $25.00 -Non-Reside nthd
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 2. G 7 $'
APPLICANT NAME: '(SIJ �GJ"9
9l
APPLICANT ADDRESS: /'tfa �tr/f/�-L eoentlin7 fl ct=l'ri B:121:714' C-11`
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SEPTIC ( CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
e_oivj 2cc C 7 t K
LOCATION MAP: Must be attached hereto before permit may be Issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: S 4.I.4, 1
OWNER MAILING ADDRESS: p ,,�Z,c,,,s . jL Q p
(moi
OWNER PROPERTY ADDRESS: A)42
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TELEPHONE NUMBER OF CONTACT PERSON: 4 9 0332 2—
TAX
TAX MAP NO. : Section / 0 G Block 9 Lot 70
CROSS STREET: ".,Q_ k411/4-6
BUILDING PERMIT NUMBER CROSS REFERENCE:
7,: !5;; a`
Signature of Appticant
RECEIVED BY:k.
L.
Town C e 's Office
DATE: A/ /70----
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/ 12 i h ,Q. ., APPLICANTS SIGNATURE:
EL=,95 2 - ' PIR�f POI APPROVAL Or C01ST U Std" FOR f. APPLICANT j,
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