HomeMy WebLinkAboutBlackham, William ,, •iii
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T Town Hall, 53095 Main Road
P.O. Box 1179
1 •,� Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 656 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOHN WALTERS
Address 1 : 160A OREGON ROAD
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
CONSTRUCT TWO 4 X 8 RINGS AND ONE DOME 15' FROM EXISTING CESSPOOL.
APPROVED WITH STIPULATIONS: BECAUSE OF HIGH CLAY CONTENT, EXCAVATE
HOLE 10'0" + DIAMETER OF SEPTIC POOL AND BACKFILL WITH APPROVED SAND
( 10' + 8') EXCAVATION INSPECTION REQUIRED. CALL 765-1802 FOR APPT.
Name Of Owner BLACKHAM, WILLIAM R.
Mailing Address 1 5 FIELD STONE LANE
City St Zip AVON CT 6021
Property Address 1 95 THIRD AVENUE
City St Zip PECONIC NY 11958
Tax Map No. section 67.00 block 6 lot 2.000
Cross Street HUNTINGTON BLVD
Building Permit Number Cross Reference:
Issue Date: 10/30/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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,y. `s Town Hall, 53095 Main Road
O p��t P.O. Box 1 179
O1 :It `i\t Southold, New York 11971
JUDITH T. TERRY 'WO 41 JP I' 1 ' TELEPHONE
TOWN CLERK (516)765-1801
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REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ° ^
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October 18, 1990 i ,I,
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To: Southold Town Code Enforcement Officer
e�.r «I
From: Linda J. Cooper, Southold Town Clerk's _ s * D
Office •T-...____,m. - ..._
Transmitted herewith is a copy of application No. A671 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
John Walters for William R. Blackham
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - X
DISAPPROVE - -y-�
COMMENTS: Hca e D 1� lX c
U-A:ttik rairmAsa. A a,..,d. 60 -* 8 i
Signature
41cts% \(:A:g-'0_4.., Cia---30-4_0(2-
AO' � 0" ja Iq 90
.-si, Date
OFFICE OF THE TOWN CLERK "',,
Town of Southold � 0 01./(41(
Judith T. Terry, Town Clerk '' � Application No. �a
Town Hall, 53095 Main Road . :L • Construction
P. O. Box 1179 f
Southold, New York 11971 to $' Alteration 2
;`'O '' : $10.00 -Residential
_
Telephone ���,�
(516) 765-1801 �! * , �' $25.00 -Non-Residential
• - ,,,,,,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE /1. /./ e qI o
APPLICANT NAME: sJ D L �` 1-3 F-f-CV',
APPLICANT ADDRESS: /k, a f j 6 L IG1, 47J& /(
SEPTIC CESSPOOL
DESCRIPTION OF PRO OSED CONSTRUCTION OR ALTERATION
.....148_._-airo._ ,.":irLi • X �� - _ di' At -
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR LTE ATION:
OWNER OF PROPERTY: W 1�� - (4t,C--:lkdb,r14A-._
OWNER MAILING ADDRESS: c Cmte(‘Pe --1-1: .,0.. L.-QIN
Or B sl- (' , 1,to t� c_ c�tc 8,66 a 1
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OWNER PROPERTY ADDRESS• 9'c 3,0 9 AO .
TELEPHONE NUMBER OF CONTACT PERSON: I p`LD & 73 e-On,3
TAX MAP NO. : Section 67 -6O1Block Lot
CROSS STREET: A--0 -7--tk1t--
BUILDING PERMIT NUMBER CROSS REFERENCE:
W
Siature of Applicant
RECEIVED BY: e__,9„,,,,,,,
oua,
Town Clerk's/Office - b
DATE: /0 - /F- 'a
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