HomeMy WebLinkAboutWirtz, Louis 0,1FFOLit
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JUDITH T.TERRY Gy TownHall, 53095 Main Road
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TOWN CLERK ; c :t • P.O. Box 1179
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Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V° ��• Fax (516) 765-1823
MARRIAGE OFFICER � #4, lig a%�/t.� Telephone (516) 765-1800
RECORDS FREEDOM OMANAGEMENT ORMA ION OFFICER =1 oges160
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1691 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CAROL AND LOUIS WIRTZ
Address 1 : 65 GIN LANE
City St Zip SOUTHOLD NY 11971
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. #R10-47-0094
Name Of Owner WIRTZ, LOUIS AND CAROL
Mailing Address 1 65 GIN LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 GIN LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 3 lot 5.000
Cross Street MAIN BAYV I EW ROAD
Building Permit Number Cross Reference:
Issue Date: 6/20/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/0��Sr�FFOC,�c
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JUDITH T.TERRY _ �� Town Hall, 53095 Main Road
TOWN CLERK y nn P.O. Box 1179
_ U ``.%'? Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
Fax (516) 765-1823
MARRIAGE OFFICER 0.1
RECORDS MANAGEMENT OFFICER *Q( O �� Telephone (516) 765-1800
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: June 20, 1997
Transmitted herewith is a copy of application No. 1761 for a Cesspool/
Septic Tank Construction Permit submitted by:
Carol & Louis Wirtz
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:
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(42-oick -)
Dated
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OFI-ICE OE 1IIE I OWN CLERK rj C§\VFULA-
Lown of Southold
/
Judith T. Terry, Town Clerk Application No./ 7�
Lown Ilall, 53095 Main Road ` Construction
P. O. Box 1179 —
Southold, New York 11971 s O Alteration
Telephone �1 * �� Residential
(516) 765-1801 � 'J711r Non Residential
TOWN OF SOUTTIOLD
SOUTIIOL_D WASTEWATER DISPOSAL DISTRICT
APPLICAI ION
for
CONSTRUCT ION or ALTERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 1 ) 7/9
9
APPLICANT NAME : --. _ —_CAROL & LOUIS WIRTZ
---------- -----------
65 GIN. LANE
APPLICANT ADDRESS: SQUTHOLD, NY 11971.4238
SEPTIC CESSPOOL
DESCRIPTIONPROPOSED CONSTRUCTION OR AL_TERAI I
8,71:2 7f4 t - -
l_OCAT-ION MAP: Must be attached hereto before (permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERAT ION :
OWNER OF PROPERTY :
OWNER MAILING ADDRESS: CAROL & LOUIS WIRTZ
65 GIN.• LANA------- ---------__------- - ---
- SOUTH-OL -PkkY-1-1971.,4238 - - - --- -----
OWNER PROPERTY ADDRESS : —
LE _ +
TELEPHONE NUMBER OF CONTACT PERSON : '
7‘$—. ..-15-iP/ GO.�
TAX MAP NO. : Section ff Block ..- Lot C
CROSS STREET :"71//)/ .A°V)////4"1/1 te,,e7
BUILDING PERMIT NUMBER CROSS REFERENCE :
//y-
Signa tuof-Applicant
RECEIVED BY : \_,,_) _
Town CI rk's Office
DATE :
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