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JUDITH T.TERRY ���0 yj • Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ����� Fax(516) 765-1823
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MARRIAGE OFFICER .1NYTelephone(516) 765-1800
RECORDS MANAGEMENT OFFICER : -1 *9„11.
FREEDOM OF INFORMATION OFFICER ,•••
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1412 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DAVID J. CONSIDINE
Address 1 : 1575 LAURELWOOD DRIVE
City St Zip LAUREL NY 11948
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-94-0053
Name Of Owner CONSIDINE, DAVID J.
Mailing Address 1 1575 LAURELWOOD DRIVE
City St Zip LAUREL NY 11948
Property Address 1 LAURELWOOD DRIVE
City St Zip LAUREL NY 11948
Tax Map No. section 127.00 block 5 lot 10.000
Cross Street PECONIC BAY BLVD.
Building Permit Number Cross Reference: 22176Z
Issue Date: 11/14/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ;o yet ‘ Town Hall,53095 Main Road
TOWN CLERK , y Z , P.O.Box 1179
REGISTRAR OF VITAL STATISTICS O 'kr 0 Southold,New York 11971
MARRIAGE OFFICER �4,, Q. / Fax(516)765-1823
RECORDS MANAGEMENT OFFICER Vd 111 4:g." Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER a�vo, ,i""°
OFFICE OF THE TOWN CLERK TO W [ '-
TOWN OF SOUTHOLD ,; i
NIrni - 3 1995 ;
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 3, 1995
Transmitted herewith is a copy of application No. 1465 for a Cesspool/
Septic Tank Construction Permit submitted by:
David J. Considine .
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 followingsrecommendations:
APPROVE
DISAPPROVE
Comments: y,-- ..e.,„, cf#01.jeteee4 / — / 1
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Signatur — /
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Date
OFFICE OF'THE TOWN CLERK ,,,,,,,,,,,
Town of Southold i'"Of 1
Judith T. Terry, Town Clerk Application No.
Town Hall, 53095 Main Road !� = Construction
P. O. Box 1179 ; c Alteration
Southold, New York 11971 .tts
Tele hone ` y0 Otri� $10.00 - Residential
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(516) 765-180101 $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE \ \- 3-°IS
APPLICANT NAME: {VJI() CL01Jf-St D 1 )\36
APPLICANT ADDRESS: \' 7 k--,PrvC jit DczNe- .sfor-v2G(
SEPTIC /CESSPOOL`''
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION N'Et&) _eliLSTeve%ar1
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 'A1/ (J S. NSl D l NC-
OWNER MAILING ADDRESS: 157S ( uRE\ (mor D 2_wC-
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OWNER PROPERTY ADDRESS: SttVkL,
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section (Z7 Block 5 Lot 10
CROSS STREET: �C:C,ON\C
BUILDING PERMIT NUMBER CROSS REFERENCE: 2Z )1 ,
I 40
'ignat ,tee o Applicant
RECEIVED BY:? .L
To Clerk's Office
DATE:
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