HomeMy WebLinkAboutVon Eiff, Donald •
JUDITH T.TERRY � Town Hall, 53095 Main Road
TOWN CLERK -'� P.O. Box 1179
P
� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS p 1
MARRIAGE OFFICER %% y 1 Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER N. 6:1 Jig $ '�� 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. 1713 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SEA BREEZE CESSPOOL
Address 1 : P. O. BOX 156
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 WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner VON EIFF, DONALD
Mailing Address 1 145 MILL CREEK ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 145 MILL CREEK ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 135.00 block 3 lot 25.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 8/15/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �•h�0 Gym Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS k O 4 � Fax (516) 765-1823
MARRIAGE OFFICER #,* ��'�•,', Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER 1 * '1►
FREEDOM OF INFORMATION OFFICER • est
OFFICE OF THE TOWN CLERK 1°91
TOWN OF SOUTHOLD 3
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 13, 1997
Transmitted herewith is a copy of application No. 1783 for a Cesspool/
Septic Tank Construction Permit submitted by:
Sea Breeze Cesspool for Donald VonEiff
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. natu
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Dated
OFFICE OF THE TOWN CLERK ,,,'"""
Town of Southold 0'`���FFD /re/
Judith T. Terry, Town Clerk ;`� Ol,.. Application No. / 7
Town Hall, 53095 Main Road Construction
P. O. Box 1179 a � :
Southold, New York 11971 Alteration
���' /_
Telephone O,j� � � $10.00 - Residential l/
(516) 765-1801 ".Ol 0 '
$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
\
APPLICANT NAME: �'/ % " i �-! 14�� •_. `, .T�.!�.v
1
APPLICANT ADDRESS: r r + 6 Afray it r • a r
SEPTIC CESSPOOL
DES RIPTION OF PROPOSED CONSTRUCTION OR ALTERATION id
S,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONS RUCTI . OR AL RAT lbN:
OWNER OF PROPERTY : Om&
OWNER MAILING ADDRESS:
-
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section Block Lot 0•N
CROSS STREET :
BUILDING PERMIT NUMBER CROSS REFERENCE:
zo_ 4 . , ;;;.;
Signature of Applicant
RECEIVED BY : _ _,4;
Town erk's Office
DATE: E�Nr�_
AUG 1 31997
tam Clerk Southold
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