HomeMy WebLinkAboutVan Dyne, Martin 41§°fFOL4
JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
'? t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS %%0 *-
MARRIAGE
MARRIAGE OFFICER :1/4* °� �1� Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER = 0.( .�al,�� 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. 1475 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL SERVICE
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner VAN DYNE, MARTIN
Mailing Address 1 4110 NASSAU POINT ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 4110 NASSAU POINT ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 111 .00 block 8 lot 3.000
Cross Street VANSTON ROAD
Building Permit Number Cross Reference:
Issue Date: 5/07/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK ti = P.O. Box 1179
T Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ` 1�
MARRIAGE OFFICER � ifJ !�t Fax (516) 765-1823
O
RECORDS MANAGEMENT OFFICER Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER - „�,.•��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 1 , 1996
Transmitted herewith is a copy of application No. A1534 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Martin Van Dyne
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
igna ure
Date
C DCC STDm.•
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OFFICE OF THE TOWN CLERK ,,,,'""
Town of Southold UVUI.ke "
Application No.
Town Clerk �b 3
Judith T. Terry, �'
Town Hall, 53095 Main Road iG ? Construction
P. O. Box 1179 Alteration ✓
Southold, New York 11971 -
Telephone ,'' , �� $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 $
DATE /9P *` P*
1,7
APPLICANT NAME: �� e"--V-11/1 -er
APPLICANT ADDRESS: 12‘ i- i i� Po
SEPTIC CESSPOOLi
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/1
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERI�TION:
OWNER OF PROPERTY: / / �/ 2-4(
OWNER MAILING ADDRESS: /6 J �c�l
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 7� )
TAX MAP NO. : Section /7/ Block re Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
-4P .tait /bi,-//'
/ Signature of Applicant
RECEIVED BY: LW/ +
own Clerk's Office
DATE: P/qC
;c: N (54 Cgokt./Corra
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