HomeMy WebLinkAboutBerry, George Jr ,�� iii
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JUDITH T. TERRY : y` Town Hall, 53095 Main Road
TOWN CLERK :
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T P.O. Box 1179
trs Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘VA, �. �� Fax (516) 765-1823
MARRIAGE OFFICER _ �� �0 ,$' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER -7�f�/1i.
FREEDOM OF INFORMATION OFFICER i�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1154 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GEORGE J. BERRY JR.
Address 1 : P. O. BOX 1924
City St Zip SOUTHOLD NY 11971
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 #R10-94-0044
Name Of Owner BERRY, GEORGE J., JR.
Mailing Address 1 P. O. BOX 1924
City St Zip SOUTHOLD NY 11971
Property Address 1 BOISSEAU AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 5 lot 21 .000
Cross Street NORTH BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 6/24/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
siii Ice°Lire^ T.
JUDITH T. TERRY
Town Hall, 53095 Main Road
TOWN CLERK : p rT+ � P.O. Box 1179
trs Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = Vv ,.. ��� Fax (516) 765-1823
MARRIAGE OFFICER �'/� ��O �� Telephone (516) 765 1801
RECORDS MANAGEMENT OFFICER '•
FREEDOM OF INFORMATION OFFICER ,,i,,��
OFFICE OF THE TOWN CLERKt
TOWN OF SOUTHOLD 3 `` -
y
1j✓.
TO: Southold Town Building Department *`` JUN 2 3 i{
FROM: Linda J. Cooper, Southold Town Clerk's Off e
DATED: June 22, 1994
Transmitted herewith is a copy of application No. 1197 for a Cesspool/
Septic Tank Construction Permit submitted by:
George Berry Jr. •
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: i 4 "A '- 9 f—4acife
ItrTiEnD
JUN 2 4 1994
Signature
Tam Clerk Southold
Date
lw
OFFICE OF THE TOWN CLERK """"' •
Town of Southold Application No. f 19
Judith T. Terry, Town Clerk ���0, G
Town Hall, 53095 Main Road `, Construction
P. O. Box 1179
Southold, New York 11971 ri% Alteration
Telephone %S Qr/ $10.00 -Residential ✓
(516) 765-180141l ' $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE lD 7.,qV/ L7
APPLICANT NAME: �j e o
APPLICANT ADDRESS: P e, ���x / 9 �(
• Sow`t1,.en (cf 1V Y ( [r7/
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Co V\`cf., or y\e how, e Qvi vac's �t
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: C r_0 P ?-e
OWNER MAILING ADDRESS: Pa l Cj 2
.50 M Y
OWNER PROPERTY ADDRESS: R r'SSe . A u
g y. l ( '7 l
TELEPHONE NUMBER OF CONTACT PERSON: 7(o S 1 I
TAX MAP NO. : Section ) Block 0 5 Lot
CROSS STREET: Mort-1-‘ Bay I > ei_w R
BUILDING PERMIT NUMBER CROSS REFERENCE:
\i'!irifitn
gn- u'- o Ap/7ant
•
RECEIVED BY:
•
Town lerk's Office
DATE: 6/c /9 •
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
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