HomeMy WebLinkAboutBerry, Glynis .401c)IfOL,t' ;-
JUDITH T. TERRY • ` ; Town Hall, 53095 Main Road
TOWN CLERK : c:=2
e= : P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = �. � Fax (516) 765-1823
MARRIAGE OFFICER '`^ ,vte 'S' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER _ 1 4ll
FREEDOM OF INFORMATION OFFICER =���•••v��i*��I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1175 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GLYNIS BERRY & H. ARRIZUMI
Address 1 : 111 FOURTH AVENUE, #2M
City St Zip NEW YORK NY 10003
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. #R10-94-0021
Name Of Owner BERRY, GLYNIS AND ARIIZUMI, H.
Mailing Address 1 111 FOURTH AVENUE, #2M
City St Zip NEW YORK NY 10003
Property Address 1 MAIN ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 18.00 block 5 lot 18.005
Cross Street PLATT ROAD
Building Permit Number Cross Reference: 22188Z
Issue Date: 8/01/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY � Town Hall, 53095 Main Road
TOWN CLERK • P.O.1-rt P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS y Southold, New York 11971
MARRIAGE OFFICER '. O�'���� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER411 '=_4Z t •11• Telephone (516) 765-1801
FREEDOM OF INFORMATION OFFICER � �,,"
! eME
OFFICE OF THE TOWN CLERK D 1
TOWN OF SOUTHOLD
t' 2 7 INN j
TO: Southold Town Building Department BLDG.DEPT.
FROM: Linda J. Cooper, Southold Town Clerk's Office TOWN OF SOUTHOLD
DATED: July 27, 1994
Transmitted herewith is a copy of application No. 1219 for a Cesspool/
Septic Tank Construction Permit submitted by:
Berry, Glynis M. & Ariizumi, Hideaki •
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 recommend • ns:
APPROVE
DISAPPROVE
Comments: s&1ØO / A2-,-.95/— L/
Signature
Dated
i .
' OFFICE OF THE TOWN CLERKFOt,?
Town of Southold *Ai CDG
Judith T. Terry, Town Clerk +' Application No. IQ
Town Hall, 53095 Main Road
cn �x tax dS Construction
P. 0. Box 1179
Southold, New York 11971 Alteration
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Telephone 1 /' Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION \ ;
for o ""
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CONSTRUCTION or ALTERATION PERMIT .11):71•:1
oma)
01
SEPTIC TANK or CESSPOOL o
Permit No. •
Fee .$
DATE April 30, 1994
Glynis M. Berry and Hideaki Ariizumi
APPLICANT NAME:
APPLICANT ADDRESS: 111 Fourth Avenue , #2M, New York, NY 10003
SEPTIC x CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Septic tank with two leaching pools, 900 gallon cylindrical type
LOCATION MAP: Must be attached hereto before permit may be issued.
see approval plan of Suffolk County Dept. of Health, attached
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Glynis M. Berry and Hideaki Ariizumi
OWNER MAILING ADDRESS:
111 Fourth Avenue , #2M
• New York, NY 10003
OWNER PROPERTY ADDRESS:Main Road, ' Orient
TELEPHONE NUMBER OF CONTACT PERSON: 212 677-7898 or 212 442-7409
TAX MAP NO. : Section 018 Block 5 Lot 18.5
•
CROSS STREET: near Platt Road
BUILDING PERMIT NUMBER CROSS REFERENCE:.. 42,(a$`y. Z
This is submitted together with an application or a building permit
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Signatur of Applicant
RECEIVED BY: /� 41,
T wn Clerk's Office
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DATE: „7/2
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