HomeMy WebLinkAboutKozora, Judy (2) r
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ELIZABETH A.NEVILLE lQ1 Town Hall, 53095 Main Road
TOWN CLERK * *; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N Southold, New York 11971
MARRIAGE OFFICER
4%
MARRIAGE
Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER � Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER �.�COUNTI°‘ 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. 3391 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : R & R BUILDERS
Address 1: P 0 BOX 555
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
-FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner JUDY KOZORA
Mailing Address 1 NORTH ROAD
City St Zip GREENPORT NY 11944
Property Address 1 NORTH BAYVIEW ROAD
City St Zip SOUTHOLD NY 11944
Tax Map No. section 79.00 block 2 lot 3.500
Cross Street
Building Permit Number Cross Reference:
Issue Date: 11/29/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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• ELIZABETH A.NEVILLE ts �O 4 : Town Hall, 53095 Main Road
TOWN CLERK ; * lig % P.O. Box 1179
N barSouthold, New York 11971
REGISTRAR OF VITAL STATISTICS k G ,�
MARRIAGE OFFICER ..%z �1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER l ,ii Telephone (631) 765-1800
EI�O�
FREQF T�TF�OFFICER =eCOU ,*fi•l southoldtown.northfork.net
1 !t I, OFFICE OF THE TOWN CLERK
4 u, ,- 7 ,`-� TOWN OF SOUTHOLD
i
_-I SonihOITijown Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 4, 2005
Transmitted herewith is a copy of application No. 3540 for a Cesspool/Septic Tank Construction
Permit submitted by:
R& R Builders
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:
APPROVEiZ
DISAPPROVE
Comments: ..-Air _ :i� _ - ��
Signature
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4.4,0,
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Dated
ELIZABETH A.NEVILLE 1.4b' 4, Town Hall, 53095 Main Road
TOWN CLERK 3 ; P.O.Box 1179
: ` Southold, New York 11971
REGISTRAR OF VITAL STATISTICS : �i• ivy �`
MARRIAGE OFFICER : G 'V$ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ' y 0. of Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER V/ 0.
�a,0 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. 35
Permit No. l
Applicant Name ^ 2.±- a— \.il k S
Applicant Mailing Address C) a C1 _
c�Y� �, o-± Nj \°R4
Septic Tank >(or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: .) UV--10 -Lo Y�a
Owner Mailing Address: �r L 1.. )(..\
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6n)r-e-f-in :3 in'-f.
Owner Property Address: N D tr`t In
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Name and phone number of contact person ef� e-A � -)1t'--.<7 C
jCrosTax Map No: 1 °‘)(. Section .19 Bloc Lot 3giro-
Cross
s Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH D PARTMENT AP ROVAL
1"---+.-e- (2)0 I NIIR,S I 1 11 9'6,--•
Signature of Applicant Dat
Received by:
03/25/2005 11:44 6312988133 PRUDENTIAL MATTITUCK ' " PAGE 03/03
SURVEY OF LOT #5
MAP OP "444E5 it 17AMON" N
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APPROVED .-IifibA!�:11:4:-7711,1,1 111
CERTIFIED TO. FOR MAXIMUM OF ' OOMS
Kemeth KaIilta 0 'IRR9THREE WARS PROM OKIEOPAPPROVAL ,
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