HomeMy WebLinkAboutZimmer, Frank (2) a
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/� \4>SUFFO(,�0oELIZABETH A.NEVILLE ?�: Town Hall, 53095 Main Road
TOWN CLERK ; Z P.O. Box 1179
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REGISTRAR,OF VITAL STATISTICS � � � �� Southold, New York 11971
MARRIAGE OFFICER L y %���� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER , �( �a ��i 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. 3153 R Residential x Non-Residential
Fee $ 10.00 septic x Cesspool
PERMIT ISSUED TO:
Name : FRANK ZIMMER
Address 1: PO BOX 355
City St Zip ORIENT NY 11957
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 #R10-03-0059
Name Of Owner ZIMMER, FRANK
Mailing Address 1 PO BOX 355
City St Zip ORIENT NY 11957
Property Address 1 29525 MAIN ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 13.00 block 2 lot 7.008
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
issue Date: 4/15/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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%SUFFoc,r=_ 3 153
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ELIZABETH A.NEVIi.i.F, ; 'y� Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
H = New York 11971
REGISTRAR OF VITAL STATISTICS v' o
Southold,
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `�y_'�pl 41g ��,•��� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,�'� southoldtown.northfork.net
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r c 2 0 2004 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 20, 2004
Transmitted herewith is a copy of application No. 3284 for a Cesspool/Septic Tank Construction
Permit submitted by:
Stacey Bishop for Frank Zimmer
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
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Signatur
20 y
Date
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ELIZABETH A.NEVILLE I 4\ Town Hall, 53095 Main Road
TOWN CLERK II'
A I P.O. Box 1179
at $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS : v t
MARRIAGE OFFICER : G kt1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER s'-,40*_ 04 0° Telephone(631) 765-1800
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FREEDOM OF INFORMATION OFFICER e'� jig 4i%, southoldtown.northfork.net
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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.3
Permit No.
Applicant Name S�coy , is mi (coni f rk ALF aC h A n)- 2(Miucr�>
Applicant Mailing Address Pb BMX 3sic 0 4-(rvrr ^)V 11 al s---7-
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Septic Tank ,- or Cesspool
Brief Description of Proposed Construction or Alteration 4A--w cowIt-uc-u3i
Location of Proposed Construction/Alteration:
Owner of Property: ��a,Ni 2(n)r-1 --
Owner Mailing Address: e a t'- ‘,) e- 3 S s
0 4 LA,-r. ivy l/g.S/-
Owner Property Address: 02 9 Sas MA i n1 K D.
04_,,....-roti--, N v t o
Name and phone number of contact person
Tax Map No: /DOD Section 016 Block 'coda Lot 7. F
Cross Street /14A(..1 2.
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
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Si Liar of A jliicant Date
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