HomeMy WebLinkAboutDeMilt, James r '
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ELIZABETH A.NEVILLE �O
y�: Town Hall, 53095 Main Road
TOWN CLERK ; g _ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �� . ��I Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `_' 4)„, 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. 3146 R Residential X Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : JAMES DEMILT
Address 1: 72 NASSAU STREET
City St Zip ISLIP TERRACE NY 11752
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 #R10-04-0020
Name Of Owner DEMILT, JAMES
Mailing Address 1 72 NASSAU STREET
City St Zip ISLIP TERRACE NY 11752
Property Address 1 1000 HILLCREST DRIVE
City St Zip ORIENT NY 11957
Tax Map No. section 13.00 block 2 lot 8.027
Cross Street SOUNDVIEW DRIVE
Building Permit Number Cross Reference:
Issue Date: 4/15/04 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
4
,g1 ISUFFOLA, 3 / �
ELIZABETH A. NEVILLE 0.0 y Town Hall,53095 Main Road
TOWN CLERK o P.O. Box 1179
CIASouthold, New York 11971
REGISTRAR OF VITAL STATISTICS �� �
MARRIAGE OFFICERFax(631) 765-6145
RECORDS MANAGEMENT OFFICER 4,, 114 0,••*
,•''• Telephone (631) 765-1800
41,
FREEDOM OF INFORMATION OFFICER - ��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
3 TOWN OF SOUTHOLD
tiim 20
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 2, 2004
Transmitted herewith is a copy of application No. 3285 for a Cesspool/Septic Tank Construction
Permit submitted by:
James De Milt
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
\Age
Comments: WV?' dO
/ i
91/4-` ,/
Signature
02-126
Dated
„ ,,,,
011 OFF04
ELIZABETH A. NEVILLE ��h`Z` G.y : Town Hall, 53095 Main Road
TOWN CLERK g P.O. Box 1179
C/3 Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V. hti 1
' • MARRIAGE OFFICER • . Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER = '� * ,,I' 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. 32-b
Permit No.
Applicant Name -1401e c C A 2/./T
Applicant Mailing Address 7s� AU4,55,i v Sr
Tei-'-Ac P ,2s )” //7.5?-
Septic Tank or Cesspool ,/
Brief Description of Proposed Construction or Alteration /3c,,./d � ,-.,' d✓►e .F1m;/y
Dwe1/,„S
Location of Proposed Construction/Alteration:
Owner of Property: - roe3 L1r), /1-
Owner Mailing Address: 71 71./A‘;.‹; 'r
3,764.P Te cc-A c e iv, y 1/7 �-
Owner Property Address: /000 /,O/cites"- L)-,.
DY i e✓) 71'
Name and phone number of contact person ,.. .I� /Will-/l 5/C -
Tax Map No: 1000 Section /3 _Block 0 Lot 3' ?7
Cross Street So/id e 17r►
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
./i` :=3//10 _
.'mature of Applic. t Date
(A.4
Received by:
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AREA = 40, X28 S ���4C,1C a APPROVED- r �FaFat ,�� , ,,�)
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Ihnauthori,ed alteration or addition to this surges is;;violation of section 7111y of the Ness fork Stair 2-14 EAST N1Akw cJT.
liducation lay, C opins of this stirs es map not hearing the Land Surveyors inked or embossed seal is 44'- t i a EAST is L P y
not considered to he a true valid cops Distances shown from propens lines to existing structures are ' 11 30
for a specific purpose and use and are not intended to guide in the erection of fences or other { ' ' Cd-6 I "- 2,1 — 3G Q eJ.
structures Centlicatton indicated hereon shall run only to the person lir is horn the stirs es is
prepared and on his hehall.to the compass or agencies listed hereon and to the assignees of the
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fendtsittUtio C ertitic:nions are not transterable to additional institutions or subsequent'milers [�A'T'E
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