HomeMy WebLinkAboutBuhler, William JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : o •
T P.O. Box 1179
to � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO �. Fax (516) 765-1823
MARRIAGE OFFICER ��jj�� .aO � Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ----_ (iJ 41 �Ii��l
FREEDOM OF INFORMATION OFFICER � �i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1063 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : THEODORE MARTZ JR.
Address 1 : 145 RYERSON AVENUE
City St Zip MANORVILLE NY 11949
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. # 93-SO-39
Name Of Owner BUHLER, WILLIAM AND HELEN
Mailing Address 1 1080 GRANT AVENUE
City St Zip PELHAM MAONOR NY 10803
Property Address 1 CEDAR AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 77.00 block 1 lot 17.000
Cross Street BIRCH AVENUE
Building Permit Number Cross Reference:
Issue Date: 12/01/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY %,• _ • Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS tri
Southold, New York 11971
MARRIAGE OFFICER =yO3
�'� Q�,'•�� TelephonFax e(516)5 765-18016)
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 10, 1993
Transmitted herewith is a copy of application No. 1095 for a Cesspool/
Septic Tank Construction Permit submitted by:
Theodore Martz Jr. for William and Helena Buhler
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: �. JGI 93.-So- 357
RECIMED Ale
.2.__ ,�
PRIV `� ' liri'� re:4
Signature
'rimy ChNii bee
Dated
•
OFFICE OF THE TOWN CLERK e.\;i:F
Town of Southold CLQ, . r. %
Judith T. Terry, Town Clerk �'r'"' "
j r=•: (. � Application No. /U5
Town Hall, 53095 Main Road •
P. O. Box 1 179 u' t=: Ft!: f=- ConstructionSouthold, New York 11971 ' nO`' � r Alteration
Telephone "el xa /% )-f� Residential
(516) 765- 1301 . ,jam
Non-Residential_______
tial
TOWN OF SOUTHOLD '
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
•
• for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
. ci....D.,TE il .
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APPLICANT NAME: /41919...11- .•Ar. E•
APPLICANT ADDRESS: A65 :',r;- ; - i
.'> 60o,/. iL, ilq)(6
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSEfl7CSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit maybe issued.
ssued.
LOCATION OF PROPOSED CONS , RU TION O ALTERA� O/11
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OWNER OF PROPERTY: 1 � ,t , _ /1 C:�
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• OWNER MAILING ADDRESS: �,i 1 S1 ;.. r
I , he , , A0 763 .
OWNER PROPERTY ADDRESS: C'../(°44 ,11/ lar,e.c4 J
TELEPHONE NUMBER OF CONTACT. PERSON: eiz
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TAX MAP NO. : Section _. !
9) . Block O .
Lot /7 f79 •
CROSS STREET: A Ur4c4•J
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BUILDING PERMIT NUMBER CROSS REFERENCE:_.
An) . . .ill., .
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Signature of Applicant
RECEIVED BY: Asi ` �__ �_/,
Town Ceerlc's Office
DATE:__ —..fj* /CS. •
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GO l'i The locations of wells and cesspools • ..
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MAP OF GOOSE BAY ESTATES
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RLED NOV. 13,1934 MAP NO. 1176
AT.SOUTHOLD
TOWN OF SOUTHOLD
. ...? ko. SUFFOLK COUNTY, NY
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e* Z c Scale: 1"= 30'
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o.--../: EXPIT9 TrIP,Er. MIS F2011 DATE OF.11'.771101, -I i'f'''' •:,A 73
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The water supply and sewage deposal ° SUFFOLK COUNTY DEPARTMENT OF HEALSERVICES I/ *
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Prepared in accordance with the minimum sysiems for this residence 4 conform FOR APPROVAL OF CONSTRUCTION ONLY ON. ,10‘,741 ,, %€2.
standards for Mlle surveys as established , lo the slandards of The Sulloik County ,A . ows,..,;.,. .'op/•Y.S. LIC. NO. 496/8
by the L.I.A.L.S. and approved and adopted Department ol Health Sorvices. NOV i 0 11.13 93 -503 9
for such use by The New York Slate Land
' DATE MS. REF.NO. -ECONYORS, P.C.
Tills Association.
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I ELEVATIONS ARE REFERENCED MAIN ROAD
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TO AN ASSY/WO DA rum AppRovED
/e.„,,•,,, sfr 8,43 SOUTHOLD, N.Y. 11971
C.P f We,/ /c.c.:24 z on.s
93-161
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