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HomeMy WebLinkAboutGiniger, Evan I SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4052 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : MARK SCHWARTZ Address 1: P 0 BOX 933 City St Zip CUTCHOGUE NY 11935 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 #R10-11-0041, FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT. Name Of Owner EVAN GINIGER Mailing Address 1 315 FLEETWOOD ROAD City St Zip CUTCHOGUE NY 11935 Property Address 1 305 EAST 91ST STREET City St Zip BEW YORK NY 10128 Tax Map No. section 137.00 block 4 lot 14.001 Cross Street HAMILTON AVENUE Building Permit Number Cross Reference: Issue Date: 1/31/12 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) lk 0 %,„ pF SOUIyo ELIZABETH A. NEVILLE,RMC, CMC • AO l0 : Town Hall, 53095 Main Road TOWN CLERK ; l�[ P.O. Box 1179 N �r Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER =yC�UIY i +� 1111 southoldtown.northfork.net 0° OFFICE OF THE TOWN CLERK , C E V ED TOWN OF SOUTHOLD D OCT 1 / 2011 TO: Southold Town Building Department BLDG.DEPT. FROM: Carol Hydell, Southold Town Clerk's Office TOWN of SDUTHDLD DATED: October 14, 2011 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4052 for a Cesspool/Septic Tank Construction Permit submitted by: Mark Schwartz for Evan Giniger Please review the application and location map and advise if this office may issue the permit. Please complete the form below and return it to me. Thank you. * * * * * * * * * * * * I have reviewed the application and locatio map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Final approval required from the Suffolk County Health Department Signature /O72—,r/ Dated imi t . 11 r . ,/,,�may`oFFOL4' ELIZABETH A.NEVILLE d� '''•�V Town Hall, 53095 Main Road TOWN CLERK p % P.O. Box 1179 REGISTRAR OF VITAL STATISTICS co%A.. �� Southold, New York 11971 MARRIAGE OFFICER : G '� Fax Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ,;WI a40�,, i�� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER =_'� ,�' 0isoutholdtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 X or Non-Residential @ $25 Application No. q as -2---- Permit _Permit No. M Applicant NameZ_ pP � fC, rl +�� l Applicant Mailing Address ;P 6 a/ ''3) Cv/"G U6v E I i .;i--- Septic Tank X or Cesspool Brief Description of Proposed Construction or Alt ration Nom/ t (//' w f A.fJ St':-r'7) C Location of Proposed Construc on/Alteration::� Owner of Property: p�'j✓ G f,f, EW EW Owner Mailing Address: .3(f £- 677ii/ e, CC , i2e__./ N / / J) _ Owner Property Address: ad— f /J f/ Ny/ A/ ( o/ Zd Name and phone number of contact person / 1/ t.K C f'/1-1- 1.T Z__ 73 1/,i- Tax J,rTax Map No: /000 Section (3 7 Block a 4- Lot / 4_ , / Cross Street NOTE: LOCATION MAP MUST BE SUBMITTE If ITH APPLICATION. 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