HomeMy WebLinkAboutBatist, Arnold o'�FOIK�oo
'*% Town Hall, 53095 Main Road
JUDITH T. TERRY • :
TOWN CLERKzz,: o ,_ : P.O. Box 1179
CP � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO Fax (516) 765-1823
MARRIAGE OFFICER _ ,�j� ,•' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER — "K/ + 0
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. 1221 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ARNOLD AND DONNA HORTON BATIST
Address 1 : 18 PAMAMOKA TRAIL
City St Zip RIDGE NY 11961
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. #93-S0-61
Name Of Owner BATIST, ARNOLD & DONNA HORTON
Mailing Address 1 18 PAMAMOKA TRAIL
City St Zip RIDGE NY 11961
Property Address 1 675 JACKSONS LANDING
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 5 lot 6.000
Cross Street WEST MILL ROAD
Building Permit Number Cross Reference:
Issue Date: 10/13/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
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o��FF01.1(
JUDITH T. TERRY
7:A ". Town Hall, 53095 Main Road
TOWN CLERK ` c T P.O. Box 1179
u") � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER .°$°I' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ' "K/ .�
FREEDOM OF INFORMATION OFFICERi�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department SEP 3 019
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 30, 1994
Transmitted herewith is a copy of application No. 1265 for a Cesspool/
Septic Tank Construction Permit submitted by:
Arnold Batist and Donna Horton-Batist •
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments: Jc 7), 1
s '400311,
Signature
/1 6 "h
Dated
f
OFFICE OF THE TOWN CLERK CS.1
SFU /� /,
Town of Southold Application No. !of 'F
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road soConstruction
P. O. Box 1179 ++ ,°� Alteration
Southold, New York 1197114741-'66
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Telephone * �► ~ � Residential
(516) 765-1801 "' 'Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTitICT
APPLICATION
for
CONSTRUCTION .or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE q_26' Iggli
APPLICANT NAME: Agl-101-4) 13,AT IST Ca 0140 PTO it/
APPLICANT ADDRESS: 18 PAU, 4OtcA TRA I1.
SEPTIC -)c CESSPOOL )(
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
II W SII..IGLe NOHE NJ 61-1-11-46
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: AgL4OLD 13,fl IST - OO4/A14 tioRrooti- NIST
OWNER MAILING ADDRESS: I0 PAW ttMDIG.ft TRAIL,
2 1 p t,t3 , 1-1,-/ ttq bl
OWNER PROPERTY ADDRESS: b75 JA Soi-t 5 I,A 4b iL1(.
MA1TLTUCk , uy tI45L
TELEPHONE NUMBER OF CONTACT PERSON: 5tb - qv - 36.63
TAX MAP NO. : Section 113 Block 5 Lot•
CROSS STREET: in/GST }TILL 120AV
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: d//17,c,,,,,i,Town Clerk's 0ice
9/ 01/./9e--7
DATE: 7/ O' 9e--7
11
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