HomeMy WebLinkAboutHeins, Janet f
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ELIZABETH A.NEVILLE �� �� lQ \; Town Hall, 53095 Main Road
TOWN CLERK ; 41s 41, ; P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS G4k �� Fax(631) 765-6145
MARRIAGE OFFICER : '�► �O �I
RECORDS MANAGEMENT OFFICER ��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER IitCOU ��` ,�'e southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3334 R Residential X Non-Residential
17ee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JANET HEINS
Address 1: PO BOX 354
City St Zip PECONIC NY 11958
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-05-0046
Name Of Owner HEINS, JANET
Mailing Address 1 PO BOX 354
City St Zip PECONIC NY 11958
Property Address 1 46010 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 75.00 block 3 lot 2.000
Cross Street SOUTH HARBOR LANE
Building Permit NLmber Cross Reference:
Issue Date: 7/08/05 Elizabeth A. Neville
Southold Town Clerk'
(TOWN SEAL)
IA IPP-
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' ELIZABETH A. NEVILLE $1 �O lQ ; Town Hall, 53095 Main Road
TOWN CLERK i * *i P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N �r Southold,New York 11971
MARRIAGE OFFICER 4 Fax Fax (631) 765-6145
N.RECORDS MANAGEMENT OFFICER ` l ° Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER -•— COUN southoldtown.horthfork.net
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1--CH t5 q._ s r' OFFICE OF THE TOWN CLERK
s TOWN OF SOUTHOLD
_i< Ai I 0 2006 !I.'.
TOI F; o own wilding Department
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FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 9, 2005
Transmitted herewith is a copy of application No. 3477 for a Cesspool/Septic Tank Construction
Permit submitted by:
Janet E. Heins
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
CIA:61'
DISAPPROVE
Comments: lazi...2.,' 7,4,oat.eitgue.: \a:et74
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Signature
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ELIZABETH A. NEVILLE � 4' OGS - Town Hall, 53095 Main Road
TOWN CLERK ; O ; P.O. Box 1179
y ft 1 Southold New York 11971
REGISTRAR,OF VITAL STATISTICS v. �f i '
MARRIAGE OFFICER Fax O t � Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER 0. el Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �0'� * S'ost southoldtown.nort hfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 I or Non-Residential @$25 Application No. (11
,� / Permit No.
Applicant Name `'iL j" �, `ELt- i/O
Applicant Mailing�U `W d_dress Pe 1 j( 3E 2I
PtettyLu_ Li I ( qS-0
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: Orbe -
Owner Mailing Addres i '& 691
Pew u, q c Hqsza
Owner Property Address: -e 2Q ID
•
Name and phone number of contact person CIA: . ' it 441. — 3
Tax Map No: Section 75 Block 03 Lot 02—
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
/
Si:s tune of Applicant ate
Received bY:
SUFFOLK COUNTY DEPARTMENT OY}Ir.ALTH 5 v a%-zbNOTE ITANE(
UMBUT FOR APPROVAL OF CONSTRUCTION FOR A bit Dept.at Health Services
aINGLE FAMILY tcrawr nia.r,vi.a,f
9/4/4<i .Rto--o6-9oti%,
DATE HS REF.NO---�. !A _ c
A OVED - > �3 $urFpik e
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FOR b�L�lCIMUM OF_.1._BEDROOMS 0' +\-
2005 iv 24 uNT
4 IRES THREE YEARS FROM DATE OF APPROVAL ( 1.9 of N 411 10.4 ta
ap
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�` SURVEY OF PROPER?
w 525 AT SOUTHOLD
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I am familiar with the STANDARDS FOR APPROVAL +P c
AND CONSTRUCTION OF SUBSURFACE SEWAGE * •k ,;,:` ,
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES If. ,," 1
and wall abide by the conditions set forth therein and on the 17
permit to construct. Att 498e
The location of weds and cesspools shown hereon are / / fib jg,?
from field tions and or from data obtained from others. �r / N,Y,, (
ANY At T,E+'A ADDITION THIS SURVEY is A VIOLA T1CYV ' CONIC YORPS, I. C.
,OF S£C17014 7209 OF ME NEW mow sTATF EDUCATION LAW. (631) -5OX FAX (63`t) 75
EXCEPT AS 1 ZC11 t 7 - V CW 2. ALL CER7VICATIONS
EON ARE'. ThYS AMP AND Ca i-ES TrONLY IF AREA=19&,90.2 SQ, f T P.O. BOX 909 1---t
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