HomeMy WebLinkAboutDoll, Edna (2) oilOS,FFO,,,,0 ELIZABETH A.NEVILLE 'yd; Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS � � � � Southold,New York 11971
MARRIAGE OFFICER `` y 1����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = �Ql $'�i� Telephone(631) 765-1800
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FREEDOM OF INFORMATION OFFICER - ft 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. 3178 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Jame : MATINE INC
Address 1: PO BOX 1925
City St Zip SOUTHOLD NY 11971
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 #R10-02-0182
Name Of Owner DOLL, EDNA
Mailing Address 1 C/O CYNTHIA SNYDER
6 DOGWOOD DRIVE
City St Zip ANADALE NJ 0000
Property Address 1 590 NORTH VIEW DRIVE
City St zip ORIENT NY 11957
Tax Map No. section 13.00 block 1 lot 5.001
Cross Street BROWN'S HILL ROAD
Building Permit Number Cross Reference:
Issue Date: 5/17/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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,I�,�o�OSOFFOfc
ELIZABETH A. NEVILLE ,_e G'y�> Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Wrrr Southold,New York 11971
MARRIAGE OFFICER 'W � Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER `�y,01 �a,���liTelephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
MAY 1 3 2004
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 13, 2004
Transmitted herewith is a copy of application No. 3318 for a Cesspool/Septic Tank Construction
Permit submitted by:
Ma Tine,Inc
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: 4.
r114 -9
Signature
Dated
Dated
„ii ofFour
ELIZABETH A.NEVILLE h`t` 4\ Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER v Southold, New York 11971
O 4 �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER %%4#0*y� 0'oil Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER '. ' 4,” 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 @$25 Application No. ' 18
Permit No.
Applicant Name /144'T/ice` /�P.
Applicant Mailing Address 0 c ), ego?` /l 2
01fia,D /J, /127/
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration COPS Pi O c.7 i/U r '
outs FAA icy 1(OOSV
Location of Proposed Construction/Alteration:
Owner of Property: c NA b
Owner Mailing Address: o C y NT'/A 514/YDt
6 0o6-W000 Da
J-A/A4/PALL LI, J
Owner Property Address:$ ) 1A1)A/1 uIl Del✓LI
0 A I O7j�
Name and phone number of contact person
Tax Map No: AOC) Section /3 Block / Lot ..
Cross Street /,3/1cuvv 15 ,f/LC 1' OAO
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH J, L ALTH DEPARTMENT APPROVAL
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S'.., ,.= A.plicant
Received by:
. _
SURVEY OF PROPERTY
AT ORIENT
TOWN OF SOUM,P_LD
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SUFFOLK COUNTY, Nm YORK
oo-13-01
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SCALE: 1 =40
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JUNE 28, 2062
JUL.,Y 3, 20C,2 freviiiont 1404
JUL Y 5, 2002 fprop. As*, P ,
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cUFFOLU COUNTY 9E?Alt 4..'11V.-Vrr3F,PallitiWilikaritES'- j
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PERMIT FOR APPIZOvAL OF CONSTROCIIONFOR A '
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. SINGLE FAMILY RESIDENCE ONLY
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EXPIRES THREE YEARS FROM DATE OF APPROVAL ..
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ELEVATIONS REFERENCED TO TOPOGRAPHIC MAP OF FIVE . * y , ,,,..---,:-,1 ,Y,S L. C. NO, 49618
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ANY ALTERATION OR ADDITION TO THIS 'SURVEY IS A VIOLATION (631) 6, 4'..5Q46/ts ..k, F A X(631) 765-1797
OF SECTION 7e09 EF NE NE W YORK STATE EDUCATION LAW. P. 0 P ' <4,i; s‘S-%
EXCEPT AS PER SEC TIE* 7209-SUBDIVISION 2. ALL CERTIFICATIONS 1 I CI -EE T
HEREON ARE VALID FOR THIS MAP AND COPIES ThEOF REONLY IF 1230 TPA* .
SAID NAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
SOUTHOLD, N.Y 119 71 0 2— 1 7 8
WHOSE SIGNATURE APPEARS HEREON
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