HomeMy WebLinkAboutSuesser, Fred JUDITH T.TERRY t � y�c 4• Town Hall, 53095 Main Road
TOWN CLERK ;
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JUDITH T.TERRY ',I� TELEPHONE
TOWN CLERK `�%%v�_•_ (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD V
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 5, 1997
Transmitted herewith is a copy of application No. 1739 for a Cesspool/
Septic Tank Construction Permit submitted by:
Fred Suesser
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 reco endations:
APPROVE
DISAPPROVE
• Comments:
RECEIVED
MAY 8 1997
Southold Town Clerk ' natu e
7/f7
Dated
t,
OFFICE OF THE TOWN CLERK ,,,,,,
Town of Southold ..�'.�c 001./( -:
Judith T. Terry, Town Clerk '' �l/ Application No.57,�J�
Town Hall, 53095 Main Road = Construction ���
P. O. Box 1179z cm *+ , Alteration
Southold, New York 11971 s •W$ '�
Telephone _ ,� $104 6,0'
(516)
$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 $ 2`/Q
DATE e�7o7
APPLICANT NAME: T �j� c -s
APPLICANT ADDRESS: C7-STs— /1/&71) c - e , -.
A/e-_- csr/{ of /' A .,t-,, - " ?.5-c.
SEPTIC 7C'ESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/ &—n) ,,-eki, - C-c .
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: f Z7 (926 S56R_
OWNER MAILING ADDRESS: 'C o ��r l/&-LS g S bL zkz#A/
02.535-- 7,6Av /€1) Cc/re�f& -zv&'
OWNER PROPERTY ADDRESS: 5-6 , (ph_ eq/
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TELEPHONE NUMBER OF CONTACT PERSON: V(3'1/ - 6d_
TAX MAP NO. : Section //0 Block O Lot 32- eY
CROSS STREET: /OIC/C-s /�l�
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of Applicant
RECEIVED B Y: . 1/(/1-4---
own Clerk's Office
DATE: ��1.�fJc
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SUPPOLK COUNTY DIPANIMINT OP MAL=IIMILVEIS
MART!OR APNIOVAL OP CONnitt/C11101V FOR A
PANTLY 11111011741' •
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IEN THREE YEARS PROM DATE OP APPROVAL
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