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ZL Town Hall, 53095 Main Road
JUDITH
CLERK TERRY o r= P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ���, Fax (516) 765-1823
'
MARRIAGE OFFICER ' ) ��� Telephone (516) 765-1801
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RECORDS MANAGEMENT OFFICER "'V ��
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. 1255 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ALLEN JONES
Address 1 : 67 WESTMINSTER DRIVE
City St Zip SHIRLEY NY 11967
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. #R10-94-0106
Name Of Owner CRON, RICHARD
Mailing Address 1
City St Zip 0000
Property Address 1 FARMVEU ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 121 .00 block 7 lot 4.000
Cross Street HARVEST LANE
Building Permit Number Cross Reference:
Issue Date: 11/28/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY :,' iC Town Hall, 53095 Main Road
TOWN CLERK : v T : P.O. Box 1179
cfs � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO �„�t% Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER MARRIAGE OFFICER -=� 1 �vO�' Fax
(516) 765 1801
FREEDOM OF INFORMATION OFFICER �
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: Novmeber 28, 1994
Transmitted herewith is a copy of application No. 1301 for a Cesspool/
Septic Tank Construction Permit submitted by:
Allen Jones •
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
DISAPPROVE
/3/ ( =>
Comments: „eze/.. � f� 4e9,/,
Signa • /•-Q�c.
D ed
OFFICE OF THE TOWN CLERK ,,,'""""C /�v/
t Town of Southold ,C�UFFD[K - Application No.
Judith T. Terry, Town Clerk %444§) r
Town Hall, 53095 Main Road !G ; Construction
P. O. Box 1179 : o Alteration
ct,
Southold, New York 11971 ct�
Telephone
%.;....0404, �.4r/ $10.00 - Residential c�
(516) 765-1801 _ 1
����,, $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $/(-D
DATE // adlq
APPLICANT NAME: lteA V(m.-P_4 ("071€ 1/4
APPLICANT ADDRESS: 6.7 k.'e 41,7A.s-,L Dt S'hpr4- /7 `1 l/9G7
SEPTIC CESSPOOL /
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION fip,.- (arjrucAz,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: PokCrQ^
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: r,r,„vea. QmeJ indh1trIc
TELEPHONE NUMBER OF CONTACT PERSON: (SVO 73y-S70()
TAX MAP NO. : Section ) ( Block -7 Lot y
CROSS STREET: 1-10,11, 54
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sign ure r of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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