HomeMy WebLinkAboutBradley, John (2) ELIZABETH A.NEVILLE ,ioS ;O4 Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
H Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS 0 sly t
MARRIAGE OFFICER s� I Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = �Q �a�,,• 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. 3170 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JEFFREY T. BUTLER
Address 1: PO BOX 634
City St Zip SHOREHAM NY 11786
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 #R10-03-0133
Name of Owner BRADLEY, JOHN & J. BUTLER
Mailing Address 1 PO BOX 634
City St Zip SHOREHAM NY 11786
Property Address 1 150 LAUREL WAY
City St zip LAUREL NY 11948
Tax Map No. section 125.00 block 4 lot 24.021
Cross Street ROUTE 25
Building Permit Number cross Reference:
Issue Date: 5/17/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
,sufFour
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ELI7.ABETH A.NEVII.LE 1140' y� Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 0 Southold,
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER y�Q �a�i�, Telephone(631) 765-1800
iNgr
FREEDOM OF INFORMATION OFFICER . .:'� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
APR 6 04 TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 16, 2004
Transmitted herewith is a copy of application No. 3308 for a Cesspool/Septic Tank Construction
Permit submitted by:
Jeffrey Butler
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: 41011P40'
7,44.0„.9,4
Signature
;)(472 .• �O
Dated
10,
ELIZABETH A.NEVILLE /4' VA
�; Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � v. � 1 Southold, New York 11971
MARRIAGE OFFICER : _ 4*°I
Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =y�� goo
Telephone (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 @$25 Application No
Permit No.
Applicant Name �� 7: Te.6 ,2
Applicant Mailing Address )(7).7 lat_ essf1
5A/0/2-6-,K447)07) // 6
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration AA-k)
Location of Proposed Construction/Alteration:
Owner of Property: 1/0 ti /3,4 2L c.
Owner Mailing Address: ,•o, Jo- 6 3
S/r' 4dx/Xin 41 L— /1-7E4
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Owner Property Address: Z-o-r- lsGov 12 GeJn y
ZAUJL,e5U �L �
Name and phone number of contact person BvrG6,2, S D
Tax Map No: Section 5 Block y Lot d-'
Cross Street "Z v i� .�
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
17-6--by
.400 f"\
Si o scant Date
Received by: /
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REF.. NO. R10-03-0133 W 1--
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OPOSED 38,_4„ LU
TWO STORY I-
4' FRAME HOUSE I
76, (6 BEDROOM'S
F.F. = 103.2 p ` I PROPOSED SEPTIC SYSTEM: r
���i\ 1-1500 SAL. SEPTIC TANK
-iv = - t-� AND I-8' DIA.xIb' DEEP �� ZIFFOI.R COI<1Ai7'y DEPARTMENT OF HEALTH$ yl Q
C.F. 101.2 `o ST SANITARY LEACHING POOL P �I
p I RRMI'T Ft7R APPROVAL OF CON jC' TON FORA O
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1 I SINGtE FAMILY RE 'I3E1�1 ONLY F-
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M I5G_JOBS/2003_JOBS/030069