HomeMy WebLinkAboutBleifeld, Charles •
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JUDITH T. TERRY z .�G : Town Hall, 53095 Main Road
TOWN CLERK ` O .2C
; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS tl $ Southold, New York 11971
MARRIAGE OFFICER
(516) 765-1823
�y� �� •• Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 782 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ROBERT LUND
Address 1 : 270 LAFAYETTE STREET
City St Zip NEW YORK NY 10012
Descripton of Proposed Construction or Alteration
NEW SEPTIC SYSTEM WITH FIVE POOL RING SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 4/11/91 .
Name Of Owner BLEIFELD, DR. AND MRS. CHARLES
Mailing Address 1 9 REGAL COURT
City St Zip ST. JAMES NY 11780
Property Address 1 ORCHARD LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 90.00 block 4 lot 19.000
Cross Street CEDAR POINT DRIVE
Building Permit Number Cross Reference:
Issue Date: 12/05/91 Judith T. Terry
Southold Town Clerk
ITOWN SEAL)
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JUDITH T. TERRY k L = Town Hall, 53095 Main Road
TOWN CLERK ,1 p T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS . i % *. , Southold, New York 11971
MARRIAGE OFFICER 1.y0 �. 4% Fax (516) 765-1823
�`Ol �to ���� Fax
(516) 765-1801
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OFFICE OF THE TOWN CLERK ;" ,, (777-777--7-7-,-- -1
TOWN OF SOUTHOLD 1l 14 O 'I '
p ,
I _°\0 , DEC - 31991
To: Southold Town Code Enforcement Officer U
From: Linda Cooper, Southold Town Clerk's Office
Dated: December 3, 1991
Transmitted herewith is a copy of application No. 806 for a Cesspool/
Septic Tank Construction Permit submitted by:
Robert Lund for Dr. and Mrs. Charles Bleifeld .
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 X
DISAPPROVE
Comments: o,,.% w.+^.,1.a4k4.9. h. & ,.
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RECEIVED \(.4.1,../t Ad. j.01.44.0 4.A.AL
Signature
._...1..) ) 1-1 4\Gt\
8 Dated
Town Clerk Southold
i
OFFICE OF THE TOWN CLERK %cSFRA' O .
Town of Southold , % . Application No. `°_
Judith T. Terry, Town Clerk r ...c. It
Town Hall, 53095 Main Road ` a r Construction
P. O. Box 1179 0 r - ,iJ Alteration
Southold, New York 11971 �!-'
Telephone �I t %0; Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE , / rQ • /fl/
APPLICANT•_NAME: ,pc--1r L A",v _
APPLICANT ADDRESS: 7-7° 1-41-1`31-re I-Tv- Si Se-7r EJ '/o/ / Y.� "i. Y 7o-ajz
SEPTIC X CESSPOOL h
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
eirNS7ieu`47- AAP-12 Se7I?c Sr-r -t ktA 401 1—re-n iv& c yrs reit-1---
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 13rz m-ti- C/ c45 0‘57c
OWNER MAILING ADDRESS: l l e--6-#-L Cov-ier
6r cihycB5, N- // 7(a _
OWNER PROPERTY ADDRESS: preC/ -i2 G ,v
5ouj"F-FaGD, N- p_
TELEPHONE NUMBER OF CONTACT PERSON: (2/2) 9¢/-.7(T
TAX MAP NO. : Section 9D Block Dg' Lot / /
- CROSS STREET: G 4IC. !°Q/,t b12-1 ✓6:-
BUILDING PERMIT NUMBER CROSS REFERENCE: f_:7GE '
40) -1A010
Signature f Applicant
RECEIVED BY : Tr_
Town Clerk's Office
DATE:
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