HomeMy WebLinkAboutCannon, Warren F
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$� Town Hall, 53095 Main Road,kg
� I P.O. Box 1179
* o Southold, New York 11971
JUDITH T. TERRY ������� �' �� /, 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. 477 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : DENIS, DONALD A. , A. I.A.
Address 1 : P. O. BOX 565
City St Zip AQUEBOGUE NY 11931
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 2/22/89.
Name Of Owner CANNON, WARREN AND WIFE
Mailing Address 1 CALVES NECK ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 4625 PRIVATE ROAD #11
City St Zip MATTITUCK NY 11952
Tax Map No. section 112.00 block 1 lot 14.000
Cross Street SOUND AVENUE
Building Permit Number Cross Reference:
Issue Date: 4/04/89 Judith T. Terry
Southold Town Clerk
TOWN SEAL)
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tin , -' ' �, Town Hall, 53095 Main Road
P.O. Box 1179
s;;) __ 01 �� Southold, New York 11971
JUDITH '—' �� 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: March 27, 1989
Transmitted herewith is a copy of application No. 487 for a Cesspool/
Septic Tank Construction Permit submitted by:
Donald A. Denis for Mr. and Mrs. Warren Cannon
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 recom' hendations:
APPROVE
DISAPPROVE
Comments:
02 L—S44 0_otsLA uv, G,.,�. o c.�Lkfil1l- Ner...01,.....D
sIL ort \ .
Signature
Dated
I •
OFFICE OF THE TOWN CLERK Oc��F JI.A'
e,#-\
Town of Southold Application No. (-kg
Judith T. Terry, Town Clerk F--• :
Town Hall, 53095 Main Road Construction
P. O. Box 1179 ‘W. Alteration
Southold, New York 11971
Telephone NttO Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE March 22 , 1989
APPLICANT NAME: Donald A. Denis, A. I.A.
APPLICANT ADDRESS: P.O. Box 565, Aquebogue, New York 11931
SEPTIC CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Construction of a single family residence
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Mr. & Mrs. Warren Cannon
OWNER MAILING ADDRESS: Calves Neck Road, Southold, New York 11971
OWNER PROPERTY ADDRESS: 4625 Private Road #11, Mattituck, NY
TELEPHONE NUMBER OF CONTACT PERSON: 516-722-3511 (D. Denis)
TAX MAP NO. : Section 112 Block 01 Lot 014
CROSS STREET: Sound Avenue
BUILDING PERMIT NUMBER CROSS REF. " ENCE:_.
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4l,
Signatu e o .•plicant
RECEIVED BY:
Town Clerk's Office
DATE:
S
SOUND �// PLEASE NOTE
Requires septic tank
iS�ANo 00.Zj cover to grade.
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N��1. r�"'0 / SUFFOLK COUNTY DEPARTMENT Of HEALTH SERVICES \
see • FOR APPROVAL Of CONSTRUCTION OF
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a o APPROVED
EXPIRES TWO YEARS FROM DATE OF APPRDUBL
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DONALD A. DENIS, ARCHITECT Of /p0 W
Aquebogue New York 11931 CO o ,— ` 0°08
Nit Tel. No. : 516-722-3511 - 5�
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