HomeMy WebLinkAboutCampbell, John (2) •,
00 � 4\
1�, ; Town Hall, 53095 Main Road
1 P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY 01 + �% .0° TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 421 R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
PERMIT ISSUED TO:
Name : CAMPBELL, JOHN C . W.
Address 1 : 52550 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES 10/13/88.
Name Of Owner CAMPBELL, JOHN C.W.
Mailing Address 1 CAMPBELL , VIRGINIA W.
P . O . BOX 1147
City St Zip SOUTHOLD NY 11971
Property Address 1 215 HARBOR LIGHTS DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No . section 71 . 00 block 2 lot 6 . 000
Cross Street WINDJAMMER DRIVE
Building Permit Number Cross Reference :
Issue Date : 11 /09/88 Judith T . Terry
Southold Town Clerk
(TOWN SEAL)
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JB Nov _ 3 11: L.§..2 , Ar : ;,„, , -.Z. ''
, Town Hall, 53095 Main Road
BLDG. DEPT. � `�' � � '�'`�
TOWN OF SOUTHOLD �+`�G',.�' x_ y P.O. Box 1179
-' .} � Southold New York 11971
JUDITH T.TERRY2 TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: NOvember 3, 1988
Transmitted herewith is a copy of application No. 427 for a Cesspool/
Septic Tank Construction Permit submitted by: .,
Dr. John C. W. Campbell .
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
DISAPPROVE -,.p r1
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Dated
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OFFICE OF THE TOWN CLERKSUFFJ(ke,
Town of Southold Q�� �y Application
Judith T. Terry, Town Clerk �_ No. a
Town Hall, 53095 Main Road Construction
r..:
P. O. Box 1179 = Alteration
Southold, New York 11971 �-
40/ if � Residential
Telephone _
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE '`3 - S"(f
APPLICANT NAME: V6/9A) C- u> Cl 24 M PA C_._
APPLICANT ADDRESS: 5-51) M13iA1 -Re)
-Rd V 't' t'3 L T, Ri.y
SEPTIC ✓ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED-CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: JO0k) CAU,Cet-Mp/3E(-1-- Y- UIP 6. 1Jet"`API -
OWNER MAILING ADDRESS: 6-2.0,—Ba)C I ` a?
SOUT-14-oL-), y. ( 017/
OWNER PROPERTY ADDRESS: a X55 ' j..n L ►dl ' JLl._Q
r77/
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section ®'i/ Block Lot
CROSS STREET: Ui IAA_ctJ (i ce .1--12._
BUILDING PERMIT NUMBER CROSS REFERENCE:.
--A--k-Q9)V C.) .
Signature of pplicank
RECEIVED BY:
REM/Mown Clerk's Office
DATE: Ato/o3 flee
Town Clerk Southold
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