HomeMy WebLinkAboutWood, Daniel ,•4of SOUryo
ELIZABETH A.NEVILLE I '`& 4 Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � G Southold,New York 11971
MARRIAGE OFFICER 1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER COU16�, Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER ry"' a 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. 3438 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DANIEL H. WOOD
Address 1: 3420 ROCKY POINT ROAD
City St Zip EAST MARION NY 11939
Descripton of Proposed Construction or Alteration
-FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner DANIEL H. WOOD
Mailing Address 1 SAME AS ABOVE
City St Zip 0000
Property Address 1 3420 ROCKY POINT ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 21.00 block 11 lot 8.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 5/25/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ' `/.... O ‘ Town Hall, 53095 Main Road
TOWN CLERK i 4i 0 t P.O. Box 1179
it REGISTRAR OF VITAL STATISTICS G � ,',�, F;j1 t Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER Ol� ���� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER COU�1,'0'1'
��i0. soutl ddtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Michelle L. Martocchia, Southold Town Clerk's Office
DATED: May 22, 2006
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 3600 for a Cesspool/Septic Tank
Construction/Alteration Permit submitted by:
Daniel H. Wood .
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: `- '/- —. -__ – sr /ter
r
Signature
40S-4/0:‘
Dated
'���,iitx g�FFO�,�co, `
ELIZABETH A.NEVILLE ,I'l.t 4Town Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
ft
REGISTRAR OF VITAL STATISTICS04 Southold, New York 11971
MARRIAGE OFFICER � y `'!'114 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER . �Q � a Telephone (631) 765-1800
= '
FREEDOM OF INFORMATION OFFICER 1 jig *,aI 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 Applicatio • r,► . QCT
Permit •.
Applicant Name RAJ?EL- if• w4p>
Applicant Mailing Address 3V070 4416- iCit M',, !°•o • ids<.5-,..3
4=467— /7,94:o,/
Septic Tank r/ or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: f1/4 N i z L- k . 1410
Owner Mailing Address: P i • 11,074 .S"y3
Ei4ST /1A, ,ON , iii 'i% // f35 • as 993
Owner Property Address: 3Y10 /laL-it( )4/,D7
£o r /7/14/A1 / 4/ .y.
Name and phone number of contact person /2c7EEI2 gt-RG-E4 , 7 Y9-O yf S
Tax Map NoW'D0 Section ,Y Block it Lot 6
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEYH HEALTH DEPARTMENT .APPROVAL
7
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Signature of Applicant Date
Received by:
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