HomeMy WebLinkAboutCarroll, Berit ''Os. COF0�4
o I`s
Town Hall, 53095 Main Road
P.O. Box 1179
41 $-,
$`- ��' 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. 325 R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
PERMIT ISSUED TO:
Name : CARROLL, BERIT
Address 1: P.O. BOX 46
City St Zip SOUTHOLD NY 11971-0000
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM
APPROVED AS SUBMITTED
Name Of Owner CARROLL, BERIT
Mailing Address 1 P.O. BOX 46
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 ROW OFF SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971-0000
Tax Map No. section 59. 00 block 9 lot 5. 000
Cross Street KENNEYS ROAD
Building Permit Number Cross Reference:
Issue Date: 4/19/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
it 'i • 15S RI
* _ ,,,
.. .c Town Hall 53095 Main Road
"t.� t/ a � ,,� ��t Ar�• P.O. Box 728
4 d Southold, New York 11971
JUDITH T.TERRY �`.
TOWN CLF.RI: TELEPHONE
REGISTRAR OF VITAL STATISTICS (516)765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
April 8, 1988
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 327 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Berit Carroll
Please review the application and location map and advise if the
project has received Suffolk County Health Department approval
and if we may issue the permit.
Please complete the form below and return it to my office.
Thank you.
egoee.;:te,„.......-.....--
%molly taw,
Judith T. Terry
Southold Town Clerk
* * * * * * * *
I have reviewed the application and location map of the project
cited above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: 0,e ^ • Q
c�..o 1�--%eL.l c. tL o� (11r .. �.n CPIf •111116.,�
.s C rid,. OLA.a---.
Signature
Date
'OFFICE OF THE TOWN CLERK �c0F14
Town of Southold CSG
Application No.
Judith T. Terry, Town Clerk 1 =
Town Hall, 53095 Main Road ` '` Construction
cin ;��;��.: �P. 0. Box 1179 0gibAlteration
Southold, New York 11971 4 �p�-
Telephone �1 Residential
(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 ~t/ bB
APPLICANT NAME: 'ec t L ' "�"t t-v� 2a cco 1
APPLICANT ADDRESS: 90
SO U-HA 0 tay .
SEPTIC k...---CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/Vey w £on rvC,' f (juii //p v'$eJ
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Be/'i egrtlo//
OWNER MAILING ADDRESS: ' PO 1343k c �o
�o 0M
/ivy
OWNER PROPERTY ADDRESS: 6)4 Nr E -- 47 c1 FC 0L U c, F F
TELEPHONE NUMBER OF CONTACT PERSON: $ ,57: 3e
TAX MAP NO. : Section 59 Block 9 Lot
CROSS STREET: /000 ' wts DF and 070-00 ' 6 0-C &,cwc/U/2•i IL/roe/list/
(-GBt, ROtu oPP ScxaniSglew AWE .)
BUILDING ERMIT NUMBER CROSS REFERENCE:
•
Iwo
eGtAACU
Signature of A.plicant
RECEIVED BY:
Town Clerk's Office
DATE: 6.t7
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TE L E DYNE POST .4 91 379
SUFFOLK CO. HEALTH DEPT. APPROVAL
H.S. NO.
df.. A:. , \ `.c i r• •, f '. —J r '. . ✓., 1,...„ .LV
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r. - . y'APPROVAL.
.^.. \: 3!-.�.� t�. .. . w.. .i .�1 i.. �4.t. +��. ate!- , r \� Cr !'�i'�!' \
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4 — - __ STATEMENT OF INTENT
•„ ""t•'�J” THE WATER SUPPLY AND SEWAGE DISPOSE
' !A1_EA.,6-;.42`� :-.t , SYSTEMS FOR THIS RESIDENCE WIL
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"' CONFORM TO THE STANDARDS OF TF-
� ,. SUFFO EPT. OF HEALTH SERVICE
' '� (S) C�
. A PLICANT -
,
j'A <4.: SUFFOLK COUNTY DEPT. OF HEALT
, •••,A'_-.v/ SERVICES — FOR AP R VAL 0
CONSTRUCTION ONLY �(--
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r/ DATE:
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H. S. REF. NO.: f
APPROVE il � of
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t+•0 SUFFOLK CO. TAX MAP DESIGNATION:
,N DIST. SECT. BLOCK PCL.
• 1O. . 059 .;Q 5 .
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/ OWNERS A R S: �(
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,/ 4 IT' / 10:i �'JL;TNOL.:? N.Y. 11971
- N./. 765-5258
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~ RODERICK VAN TU, (J,.. P.C. C.CA2SE +. t:syr
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LICENSED LAND SURVEYORS 21 ''�CAn�J
GREENPORT NEW YORK