HomeMy WebLinkAboutBransfield, Peter 4
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% �,�. Town Hall, 53095 Main Road
+'���0 N�0�-.*. P.O. Box 1179
ooi' 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. 635 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PETER BRANSFIELD
Address 1 : 245-10 GRAND CENTRAL PARKWAY
City St Zip BELLROSE NY 11426
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
ON 8/2/90.
Name Of Owner BRANSFIELD, PETER
Mailing Address 1 245-10 GRAND CENTRAL PARKWAY
City St Zip BELLROSE NY 11426
Property Address 1 HIAWATHAS PATH
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 3 lot 42.003
Cross Street NAKOMIS
Building Permit Number Cross Reference:
Issue Date: 8/28/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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TOWN OF SO HOLD $ Town Hall, 53095 Main Road
4 �- • P.O. Box 1179
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Southold, New York 11971
JUDITH T.TERRY + ��� ,/
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TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: AUGUST 9, 1990
Transmitted herewith is a copy of application No. 651 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peter Bransfield
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: c e�p � p� $ JM..
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Signature
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Dated
OFFICE OF THE TOWN CLERK "'''''
Town of Southold •
', ' _ application No. `S/
Judith T. Terry, Town Clerk 4 ` '.�
Town Hall, 53095 Main Road G Construction
P. O. Box 1179 Alteration
Southold, New York 11971 ;� � `
Telephone �,'� $10.00 -Residential
(516) 765-1801 * ''' $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 . O
APPLICANT NAME: S72-11 & rU.S /Z1
APPLICANT ADDRESS: z;?/{S f0 6:f9' ii? C Cnzi—A/7G. 714-/•
2,-0.905 a. / ..Z G
SEPTIC C/6ESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
n'e-e,s-Aerc
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRU TION OR ALTERATION:
OWNER OF PROPERTY: "9.r,5.=-iaZ/9
OWNER MAILING ADDRESS: ,244,5 l(' erfroeVarz, J Cc W2C 4, '
OWNER PROPERTY ADDRESS: ///mv7
TELEPHONE NUMBER OF CONTACT PERSON . 2‘9"-- ,--03 Z7
TAX MAP NO. : Section Block 03 Lot 92
CROSS STREET: A�//3/Lurr!/,5
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: MOM
Town ClerA UVyy bGipi s,,
DATE:
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ued in accordance with the minimum Scale 1" = 20' .'� ✓
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