HomeMy WebLinkAboutWilliamson, George 0$,�\�S�FFO1 c
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JUDITH T.TERRY t/=�0 . . Town Hall, 53095 Main Road
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TOWN CLERK y P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER ��� Fax (516) 765-1823
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RECORDS MANAGEMENT OFFICER _ 0.1IJ '*� �� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1722 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DONALD A. DENIS
Address 1 : P. O. BOX 565
City St Zip AQUEBOGUE NY 11931
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 #R10-97-0110
Name Of Owner WILLIAMSON, GEORGE
Mailing Address 1 176 WOODLAND AVENUE
City St Zip VERONA NJ 7044
Property Address 1 ARBOR LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 121 .00 block 1 lot 1 .005
Cross Street BERGEN AVENUE
Building Permit Number Cross Reference:
Issue Date: 8/26/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY 11�� Gym ') 5 Town Hall, 53095 Main Road
TOWN CLERK ; y = ; P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %%Ilk
MARRIAGE OFFICER *4" y� O-l/l Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER �( �a ill Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER - ,,�°�I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 25, 1997
Transmitted herewith is a copy of application No. 1793 for a Cesspool/
Septic Tank Construction Permit submitted by:
Donald Denis for George Williamson
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.
1$'4 )cd-°`
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
AUG 2 6 1997
Signatu
Southold Town Clerk f - )
Dated
i1ttaL ato
OFFICE (•)1 . 1.1I1 TOWN CLERK
. I owii of Soutllold Application No
.lrrdilh T . Terry, Town• Clerlc ,�.-
Town Hall, 53095 Main Road •s Construction
cn
P. 0. Box 1179
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Southold, New York 11971 Alteration
Telephone /0-� 4t :ef(- Residential
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(! 16) 765 1001 """'� Non Ilesidcnlial
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TOWN OE SOU I'IlULI.)
SOU 1.11OI1) WAST EWA FElt DISPOSAL. DISTRICT
nl'I'I ICA'I It)t'I
for
CONSTRUCT ION or ALTERATION PERMIT
SI_I'1 IC TANK or CESSPOOL
Pei roll Ddu.
I ('O $ 10.00
DAVE
8/20/97
APPLICANT NAME: Donald A. Denis,- A.Y.A., P.C.
APPLICANT ADDRESS: PO Box 565, Aquebogue: NY 11931
SEPTIC x CESSPOOL x
DESCRIPTION Or PROPOSED CONSTRUCTION OR ALTERATION
Proposed sine___f.it residence.-
LOCA•I ION MAP: Must he attached hereto before permit. may he Issued.
• LOCATION OF PROPOSED CONS F RUCT ION OR ALTERATION :
OWNER OF PROPERTY : George Williamson
OWNER MAILING ADDRESS: 176 Woodland Avenue
Verona, NJ 07044
OWNER PROPERTY ADDRESS: Arbor Lane
Mattituck, NY
TELEPIIONE NUMBER OF CONTACT PERSON Donald DenisLArchitect 722-3511
TAX MAI' NO. : Section 121 Biosis 1 Lot P/0 1.5
Cl t O S S STREET : Bergen Avenue
BUILDING PERMIT- NUMBER CROSS REEE _NCE : if
to
igna lure of App cant
RECEIVED I3Y : ::„6, •
Town erlc's Office
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SUFFOLK COUNTY
DEPT. OF HELIERVICE F
RIVERPj
97 JUL 11 P12 :05
suPFULK COUNT?DEFAR111ENT OF IIRALrii BEAVICHS
Plalair POI APPISOVAL 0.,_CaritntUCTION'OR A
DATE L.."..Z.21"414C- " /: 1 :_jk__‘ipp. .43Y 416"141141 6°141:7 - 0// 0
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APPROV8D .
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POR LLUMMuIf of,... .BaDaooms
r EXPIRES THREE YEARS FROIN DATE OP APPROVAL
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