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Home My WebLink AboutForrestal, Rory ELIZABETH A.NEVILLE _=�� O7� Town Hall, 53095 Main Road TOWN CLERK y Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER y O�� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �Ql .�� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3112 R Residential X Non-Residential Fee $ 10.00 Septic x Cesspool PERMIT ISSUED TO: Name : JENNIE L. FORRESTAL Address 1: 1065 SALTAIRE WAY City St Zip MATTITUCK NY 11952 Descripton of Proposed construction or Alteration ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTINO REQUIRED. R10-03-0008 Name Of Owner FORRESTAL, RORY & JENNIE ------------------------------ Mailing Address 1 1065 SALTAIRE WAY ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Property Address 1 1065 SALTAIRE WAY ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Tax Map No. section 100.00 block 1 lot 23.000 ------ --- ------ Cross Street WAVE CREST AVENUE ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 1/29/04 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) i O ELIZABETH A.NEVILLE /�'�� Gy Town Hall, 53095 Main Road TOWN CLERK o P.O. Box 1179 ti Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MA.I?RIAGE OFFICER �y • �� Fax(631) 765-6145 ,L RECORDS MANAGEMENT OFFICER "'/Ql �a� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net Q GUij OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: October 20, 2003 Transmitted herewith is a copy of application No. 3247 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Jennie L. Forrestal 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. Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: / APPROVE DISAPPROVE Comments: Maintain required setbacks from adjacent wells, buildings,property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. j� Signature D •� a3 Dated ELIZABETH A.NEVILLE h`Z`� Gy Town Hall, 53095 Main Road TOWN CLERK p P.O. Box 1179 CA Z Southold, New York 11971 REGISTRAR,OF VITAL STATISTICS MARRIAGE OFFICER • Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER 'y�IJ�l �aO� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10"I/ or Non-Residential @ $25 Application No. 3 Permit No. Applicant Name J ()o n►� E' I- f U r r(?-34 c Applicant Mailing Address Iy(c Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration is ace, i e-- Location Location of Proposed Construction/Alteration: Owner of Property:_ 0 Owner Mailing Address: 10 C, S +a '� l,UU Owner Property Address: /,I Name and phone number of contact person '3 en Y); �L o2Cj'e"� l Tax Map No: Section 10 d Block I Lot o2 Cross Street W CC CSA fl V2 NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTI4 DEPAR NT APPROVAL U /� C� ---� Signa re of Applicant-) Date Received by: TOWN OF --50u71-104z:;' SUFFOLK COUNTY N.Y. OFFSETS FROM STRUCTUR CO. CLK. NO. FILED,_' G. ,4TES TO RELATIVE BOUNDRYES, , / ON SURVEY, ARE FOR A d V , vIg SPECIFIC -USE ONLY, A D c� �-- D SHOULD NOT BE US D FO �"j (34 CONSTRUCTION OF FE C OR OTHER STRUCTU �Z 7 3 00 : a �t Q i S °o SUF K -53U DEPARTMENT OF HEALTH SERVICES _ R EsT4 Pi: Ct I T FOR A?Pf�O L OI✓CO Tltl1C ti FQR A ,gy 4 1; LE FAMILY RESIDENCE QNLY �- d2l�JPca>-•yo ASP/,�AC7 OevE � Flo J? HS REF.NO. /�a - 0 .oC7, LArP P ROVED FOR h 111M, M OF BEDROOMS -.0 T ti EXP?Rt :�, 0F APMOVAL 7.3 00 X30" ` 71-17 PLEAS NOT * 4 m t it is the applicant's respons flit y maintain adequate sanitary S between all water supply and s disposal facilities. i