HomeMy WebLinkAboutBissett, James ELIZABETH A. NEVILLE _� 7� Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
REGISTRAR.OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICERFax (631) 765-6145
RECORDS MANAGEMENT OFFICER y��,� .�� 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. 3121 R Residential X Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : JAMES BISSETT
"address 1: 323 LONG ISLAND AVENUE
city St zip HOLTSVILLE NY 11742
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR ONE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-03-0124
Name Of Owner BISSETT, JAMES
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Mailing Address 1 323 LONG ISLAND AVENUE
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City St zip HOLTSVILLE NY 11742
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Property Address 1 55 COX NECK ROAD
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city St zip MATTITUCK NY 11952
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Tax Map No. section 113.00 block 7 lot 19.023
------ --- ------
Cross Street
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Building Permit Number Cross Reference:
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Issue Date: 1/29/04 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
C ,
ELIZABETH A.NEVILLE OGy� Town Hall,53095 Main Road
TOWN CLERK H - P.O. Box 1179
REGISTRAR.OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER y Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �Ql �a0 Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
A 4,3 TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 12, 2003
Transmitted herewith is a copy of application No. 3256 for a Cesspool/Septic Tank Construction
Permit submitted by:
James Bissett
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:
Signature
Dated
o�osoFFo��.�,
ELIZABETH A.NEVILLE h`Z` �G.y Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
=
REGISTRAR OF VITAL STATISTICS y Southold, New York 11971
MARRIAGE OFFICER Gy !� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICERTelephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER O'� 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 or Non-Residential @ $25 Application No. 3aSl�
Permit No.
Applicant Name c S l3 /1Se
Applicant Mailing Address 3 a ti .B �c /0/7�0/Y
Septic Tank-Z,, or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: I Jc —
Owner Mailing Address: �d 3 hI- Avg-
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Owner Property Address�5K' ex
Name and phone number of contact person /ro�3 c/A2
Tax Map No: Section ( 13 Block d Lot
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HE H DEPARTMENT APPROVAL
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Signat of Ap�licant Date
Received by: ,,
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Young & Young
400 Ostrander Avenue, Riverhead, New York 11901
631-727-2303
Howard W. Young, Land Surveyor
Thomas C. Wolpert, Professional Engineer
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Robert C. Tast, Architect
Pfuhl. Landscape Architect
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