HomeMy WebLinkAboutUde, Denise �SUF FO(,,-c�
ELIZABETH A. NEVILLE 1$,`ti y ` Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS I
MARRIAGE OFFICER ` �* P Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER � /�l � � Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1803 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DENNIS R. UDE
Address 1 : 57 MASON AVENUE
City St Zip BABYLON NY 11702
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 #R10-97-0009
Name Of Owner UDE, DENNIS R.
Mailing Address 1 57 MASON AVENUE
City St Zip BABYLON NY 11702
Property Address 1 1227 PINE NECK ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 5 lot 36.000
Cross Street NORTH BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 2/04/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
�OF F014'
ELIZABETH A.NEVILLE � ' %. Town Hall, 53095 Main Road
TOWN CLERK c P.O. Box 1179
• CI 2 Southold, New York 11971
•REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER ti 0-1 Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER
•
FREEDOM OF INFORMATION OFFICER O@ .00
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: January 30, 1998
/ Cf"7 2
Transmitted herewith is a copy of application No. 3 - for a Cesspool/
Septic Tank Construction Permit submitted by:
Dennis R. Ude
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 mendations:
APPROVE
DISAPPROVE
Comments:
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Judd,' l�. l�en�y' Tu�o C|ar� a. Application N, iff
Town |/oU' 5p95 Main Road Construction *'
Uihox | 179 ' -' - --
P. .
/` Alteration
Southold, New York 11971 --- '
� Residential �~
Telephone ' -�'- _ •
(516) 765- 1801 z�/« Non.Residential
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TOWN OF SOUT|K)LD
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SoUT||OLU WASTEWATER DISPOSAL D|ST|z|CT
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CUNSTRU[[ION mr ALT[{</\TION PERMIT
• SEPT IC TANK o. CESSPOOL
Permit No.
Fee $
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APPLICANT NAM : ____________
N'|`|]CAN[ ADDRESS: -5 7r
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I)ISCRI P1 ION OF PROPOSED CONSTRUCT ION OR /\L[BR/\TION
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LOCATION MAP: Must be attached hereto before permit may be Issued.
• LOCATION OF PROPOSED CONST RULTION OR ALTEHATION :
OWNER OF PROPERTY :
OWNER MAILING ADDRESS : .~/
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OWNER PROPERTY ADDRESS : 4e,Z7
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TELEPHONE NUMBER (�F (�0NT/\Cl� PERSON : -, 'w, ' —� ' ~~*, , �
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TAX &|N^ NO. Section ,070 Mock u� � Lot q��
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CROSS STREET : �-_4:4
|HUU])|NG PERMIT NUK413B< CROSS REFERENCE : �-
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° Signature of Applicant
RECEIVED -1/
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DATE : / -7
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NOTES:
HEALTH "I am familiar with the standards for approval
DEPARTMENT and construction of subsurface sewage disposal
STATEMENT systems for single family residences and will
abide by the conditions set forth therein and on
the permit to construct "
SIGNED: ' .1 1�d>[! —
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ONF 51NGLE
P,MIL1 TRE€IC
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