HomeMy WebLinkAboutBraslow, Robert r
`8 F,�► Town Hall, 53095 Main Road
yO �. e$ P.O. Box 1179
1 � 000' Southold, New York 11971
JUDITH T.TERRY 0'.,,,,„„ � 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. 460 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : BRASLOW, ROBERT
Address 1 : 1428 DEER PARK AVENUE
City St Zip NORTH BABYLON NY 11703
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 12/12/88
Name Of Owner BRASLOW, ROBERT AND JOHN
Mailing Address 1 1428 DEER PARK AVENUE
City St Zip NORTH BABYLON NY 11703
Property Address 1 GREENFIELD LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 4 lot 5.013
Cross Street BARLEY LANE
Building Permit Number Cross Reference:
Issue Date: 1/30/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.. ,,,,,,,, 966
OFFICE OF THE TOWN CLERK COFOUre'
Town of Southold ��
Judith T. Terry, Town Clerk ,F, - ' ) Application No. q6,'?
Town Hall, 53095 Main Road cin �-i: . i '� Construction
P. 0. Box 1179 0,'CU
4E.)...-.71
Southold, New York 11971 0- CU _ Alteration
Telephone 01 t ��O Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ \O •O C'
DATE ES-Y
APPLICANT NAME: /21:l.2g-T 132/9;-V91-41
APPLICANT ADDRESS: /'f.2 g &ze2 2 /�d
ifie
A/0/214O ev' /X // 77 a
SEPTIC CESSPOOL
DESCRIPTION OF PR POSED, CONS RUCTION OR ALTERATION
AA/ R-e,y/e_e Al 57 r c /' '. wo or_) P, r e
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION"" OR ALTERATION:
F OWNER OF PROPERTY: 0 fBR,T HSS\p(JS -34,,\f "-BS(vtl
OWNER MAILING ADDRESS: /1,26 . eetelee)6 Jay
M 846/0.11 ply, I( 703
OWNER PROPERTY ADDRESS: /L01;1, (LrLr / 4LT)
I
TELEPHONE NUMBER OF CONTACT PERSON: 9W-1/5(7Z Dte 6,,, 76 ,Soc
TAX MAP NO. : Section 5",'. ' Block 0 d Lot 005, 0/3
CROSS STREET: 6',Ceenx6&LJ L, ive �-- glir2/7 //V.//,P,
BUILDING PERMIT NUMBER CROSS REFERENCE:_
b7:(,,/ /72 '--(k/(// '
Signature of Applicant
RECEIVED BY: (-
�C-u
Town rk's 0 ice
DATE: 1 /-,7t, -t5
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SURVEYED FOR:- .�OB8•
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i.V _JA, ./ .B,:q..SL ow C
Pitb/JE 6.c„7 �Sv o
LOCATED AT c..5-DG/77/040, , TOWN OF So,-/P/OLD , SUFFOLK COUNTY N.Y.
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TO RELATIVE BC:Lii`iL+.eY Lit+EE', �ILF S .3/.3 FILED A/r�✓/O, /9Z5
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M RaSIMMUN
Cf�/�DG^o �rCE' /iVSGIeQ0t/CE' 3�io WILLIAM
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/` i NOS G.ea.E�,c-�E L�.7 C 4� � WILLIAM R. SIMMONS JR.
1... ',45- cr suipc-.acE) P/O BOX 377
• �j JAMESPOR T, L. I., N. Y. 11947
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