HomeMy WebLinkAboutBenson, Lance , #F
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JUDITH T.TERRY
yJ► Town Hall, 53095 Main Road
TOWN CLERK y = P.O. Box 1179
PPI �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER y4/ O�I,1�� Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER : O! 3111 �aj0 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER s"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1407 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LANCE H. BENSON
Address 1 : 48 AVENUE K
City St Zip KINGS PARK NY 11754
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. #R10-95-108
Name Of Owner BENSON, LANCE H.
Mailing Address 1 48 AVENUE K
City St Zip KINGS PARK NY 11754
Property Address 1 LANDS END ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 9 lot 27.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 10/27/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ;0 4 N Town Hall,53095 Main Road
TOWN CLERK ti Z % P.O.Box 1179
rrt'll Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 1 Fax(516)765-1823
MARRIAGE OFFICER .y� �0�11/
RECORDS MANAGEMENT OFFICER --:q-1 lig `�► • Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER '—�,,i. ,s•'
OFFICE OF THE TOWN CLERK ' '; (` i` '� ' �s
, ,
TOWN OF SOUTHOLD i
L;.` i 3 IQ(6
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Offic z SL-' `? -
DATED: October 20, 1995 �- " "
Transmitted herewith is a copy of application No. 1 460 for a Cesspool/
Septic Tank Construction Permit submitted by:
Lance H. Benson .
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: 4'--rf _ ,re i ,„x///e/0 ,-?J - boy
Sign- ure /
to ;Aes— 9.5'
Dated
OFFICE OF THE TOWN CLERK ,, •
Town of Southold s''.,C��FFU��`+O Application No.;/ Y6:7
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road � = Construction
P. 0. Box 1179 •
Alteration
Southold, New York 11971
Telephone �y0 ° , $10.00 - Residential
(516) 65-1801 1 J ,$, ' $25.00 - Non-Residential
• -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
QFCFJvED
Permit No.
Fee $ OCT 2 0 1995
DATE /0I . Oli4t6eld Iowa Clerk
APPLICANT NAME: L qrce_ N . iSerSvh
APPLICANT ADDRESS: `t Ave_ X
SEPTIC v' CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION Neu F crus
LOCATION MAP: ' Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Lcu c e,_ 4 f.lei?— _c, _.
OWNER MAILING ADDRESS: cfr K
c34ckttiia,X 1175
OWNER PROPERTY ADDRESS: L6I- .27 Lor seJ
TELEPHONE NUMBER OF CONTACT PERSON: 26c — 4756
TAX MAP NO. : Section S Block 09 Lot 2
CROSS STREET: Rac-r_ 5-
BUILDING
BUILDING PERMIT NUMBER CROSS REFERENCE:
g-a,rt.c.A..._ (4-
Signature
4Signature of Applicant
RECEIVED BY: )C12-0
Town erk's Office
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DATE: ((� 'c'O ' 5
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