HomeMy WebLinkAboutAdams, Antone y-
Town Hall, 53095 Main Road
vO �� P.O. Box 1179
_ �0��� Southold, New York 11971
450/
JUDITH T.TERRY ... i FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
REGISTRAR OE VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 575 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ADAMS, ANTONE
Address 1 : P. O. BOX 286
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITIION OF NEW OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. NOTE: EXCAVATION INSPECTION REQUIRED. CALL
765-1802 FOR AN APPOINTMENT.
Name Of Owner ADAMS, ANTONE C.
Mailing Address 1 P. O. BOX 286
City St Zip MATTITUCK NY 11952
Property Address 1 MAIN ROAD
r
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 4 lot 13.001
Cross Street CARDINAL DRIVE
Building Permit Number Cross Reference:
Issue Date: 1/31/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold Application No. 55 !.3
Judith T. Terry, Town "Clerk' r
' `
Town Hall, 53095 Main Road PRConstruction
P. O. Box 1179 **/ Alteration
Southold, New York 11971 lit
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Tele hone ./ * / � Residential
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(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. ,-5-175-
Fee
17y •Fee $ /1)--
DATE
D—
DATE /-- .9 /` 9c
APPLICANT NAME: 4a.e.„ ,, �i�Ctncr G.
APPLICANT ADDRESS: P. 0- b - .2e4
SEPTIC CESSPOOL —
DnnESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: aaeA,
OWNER MAILING ADDRESS: p a (3 0284
Lnico(fcb.4cic.,J p(f ((4sa-
OWNER PROPERTY ADDRESS: Linc{_4;),, ,
hnca4- 1 i19S2
TELEPHONE NUMBER OF CONTACT PERSON: 2 .cf — zf 9 76
TAX MAP NO. : Section / / 5 Block Li Lot / 3. I
CROSS STREET: c2 ( i It y,�,
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: cer i,c.Ctc,_
Town C erk's O ice
DATE: / 3 / / c/o
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