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HomeMy WebLinkAboutMcCarty, Theresa (2) SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4098 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : THERESA MCCARTY Address 1: 24 FIRST AVE City St Zip EAST ROCKAWAY NY 11518 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #R10-12-0037 FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT. Name Of Owner THERESA MCCARTY Mailing Address 1 24 FIRST AVE City St Zip EAST ROCKAWAY NY 11518 Property Address 1 330 WESTLAND ROAD City St Zip SOUTHOLD NY 11971 Tax Map No. section 59.00 block 2 lot 24.001 Cross Street BIRCH ROAD Building Permit Number Cross Reference: Issue Date: 8/14/12 Elizabeth A. Neville Southold Town Clerk fii0FFO(, c ELIZABETH A.NEVILLE,MMC o�Z►4 O �� 4 Town Hall,53095 Main Road TOWN CLERK % p P.O. Box 1179 t y W ` Southold,New York 11971 REGISTRAR OF VITAL STATISTICS `..,‘bet �� MARRIAGE OFFICER le, `���� Fax(631)765 6145 RECORDS OF MANAGEMENT OFFICER `Zvi ,, '1►`� o. Telephone(631)765-1800 FREEDOM OF INFORMATION OFFICER ��' southoldtown.northfork.net .� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD jj7 ``� I i� ',;ii Ire TO: Southold Town Building Department J u l_FROM: Carol Hydell, Southold Town Clerk's Office DATED: July 30, 2012TOSOUTNn' Transmitted herewith is a copy of application No. 4098 for a Cesspool/Septic Tank Construction Permit submitted by: Theresa McCarthy 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. * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: / APPROVE '" DISAPPROVE ..��" Comments: . ;t-=-C ' Z r.26.4-4.--.?9 Signature g--'(..:1-g— De,/C)-) /2— Dated /rr r ELIZABETH A.NEVILLE tit V i q`t` r �. Town Hall, 53096 Main Roav TOWN CLERK ". ,. P.O. Box 1179 REGISTRAR OF VITAL STATISTICS % � Southold, New York 11971 MARRIAGE OFFICER I� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER '..:14), _,y��`�ri� Telephone (631)765-1800 FREEDOM OF INFORMATION OFFICER rrr' southoldtown.northfork.net •-.....err OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT ' APPLICATION 0 , CONSTRUCTION or ALTERATION PERMIT _ CESSPOOL or SEPTIC TANK Residential @$10 / or Non-Residential ®$25 Application Nog ©` Permit No. Applicant Name /heresg. H(' 6 ,-- Applicant Mailing Address -r .1 - t _ ,a r A Ai_ .1 , ley /_/ s / y Septic Tank ✓or Cesspool Brief Description of Proposed Construction or Alteration 17)62_ a l., 4-10,---, o4- -px,S-}-1 i - Sro,2- F K'wl FEti CDS'n.)CE_ `[77 rrcN/( 1C>1' _0 12 N*) -2--- '1--0 (.1--)C ERA'-'t€- '?-€-S ‘I.E.(V C-E Location of Proposed Construction/Alteration: Owner of Property: 1 in e-v-e O M C v Owner Mailing Address: g-.4 F► r`. -f A- yc_ . \a5-+- RO C wC4- 14(_, \1st w Owner Property Address: 1 - o f's_Vo-y-kci. 'FA, ©s,. -k [d lq[ \l9 Name and phone number of contact person TlA-e..re.S ft C Cc,r ' v, Sfc„ 1 2_1-01 o Tax Map No: Section 69 Block p 2 Lot a4 , Cross Street i5ti r Ro 3-Cl NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY II HEALTH DEPART I, °T APPROVAL /14A-4d 0— (r ':2-4 "2._ . gnature of Applicant t :to Received by: sj____ ,41, ►V\ ( ' 6 O�C Je G 5Q Ak • / D°� .)0 / ••,I, .Q opo•. S <O a -0.\)" 0• Qpma '÷p � 1•O s iG Ql < xt.,, c9 O�Qoe O ��� / ��• • ��, 2sF< Oy�5 / s L.),..., .)c.' 5 QP y1��/ TEST HOLE �. P� C.,<C, Q-� :i