HomeMy WebLinkAboutBurk, Ronald }cOFrlur
Town•Hall, 53095 Main Road
-Q ti°. is P.O. Box 1179
fit i j � ' - Southold, New York 11971
JUDITH T. TERRY "'H if TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
December 31, 1987 ._
Ronald G. Burk
169 East Madison Street
East Islip, New York 11730
Re: 145 Hickory Road
Southold, New York
Dear Mr. Burk:
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10.00) for
residential use and twenty-five dollars ($25.00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly ?fours,
err✓
11.1
Judith T. Terry
Southold Town Clerk
Enclosures (3)
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„ 1
OFFICE OF THE TOWN CLERK �FFOCK�,
Town of Southold OHO
Judith T. Terry, Town Clerk w; s..A4
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971OOl � .'
Telephone c
(516) 765-1801 ' ��
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCT ION OR ALTERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 274 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
PERMIT ISSUED TO:
NAME: Ronald G. Burk
ADDRESS: 169 East Madison Street
East Islip, New York 11730
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling with Cesspool System
APPROVED as per Suffolk County Health Department approval.
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Ronald G. Burk
OWNER MAILING ADDRESS: 169 East Madison Street
East Islip, New York 11730
OWNER PROPERTY ADDRESS : 145 Hickory Road
Southold, New York
TAX MAP NO. : Section 54 Block 9 Lot 6
CROSS STREET: Chestnut
BUILDING PERMIT NUMBER CROSS REFERENCE:
ors_theor.„,„
Judith 17. Te�
Southold Town Clerk
DATE : December 31 , 1987
(TOWN SEAL)
•
w-• ; f...r�
^/ Town Hall, 53095 Nlain Road
` P.O. Box 728
•
Southold, New York 11971
JUUITII T.TERRY
TELEPHONE
REGISTRAR OF VITAL STATISTICS (516)76$-1501
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
December 29, 1987
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 21 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Ronald G. Burk • - -
Please review the application and location map and advise if the
project has received Suffolk County Health Department approval
and if we may issue the permit.
Please complete the form below and return it to my office.
Thank you.
eir •
e.044
Judith T. Terry
Southold Town Clerk
* * *
I have reviewed the application and location map of the project
cited above and make the following recommendation:
APPROVE —
DISAPPROVE —
Ol.o ,�,�. n-
COMMENTS: � c �, 'd QI �'J�- 1
A c-.'V.A..
Signature
Date
44 ��..
0
OFFICE OF THE TOWN CLERK COFOUr
JudithTown of Southold
Town Clerk COQ ' Application No.<2 7�
Terry, � .
Town Hall, 53095 Main Road ` 8 Construction p
P. O. Box 1179
Southold, New York 11971 *.$ Alteration
Telephone '40 i[ 0;6'
[ ��O 6 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 9-cc_ e '/ / S'7
APPLICANT NAME: 0#109-(... 0 6 — (3 (JR Ic
APPLICANT ADDRESS: /6 c—_ Moo/oo/ y i J(
6 , Esc r r / N-Kr / 03 (i
SEPTIC CESSPOOL
DESCRIPTION` OF PROPOSED CONSTRUCTION OR ALTERATION
/ ff ui Sid 6 c cc f.R'M. / L +/ hid 44A L
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 0 .c 4c Cj - #3 v/I (('
OWNER MAILING ADDRESS: /,( 5 G /vI Api 1e,v 5---
6-- .TS c. c p /A/ >' 1173`1
OWNER PROPERTY ADDRESS: / (/ 5C !`oK/ 67C/
5-ei,.7(4c,(cc"/ A/Y / /, 171
TELEPHONE NUMBER OF CONTACT PERSON: (5/C) P77- 37/3 7
TAX MAP NO. : Section c,...5--y Block ? Lot a
CROSS STREET: C-#63.7-Ncr7-
BUILDING PERMIT NUMBER CROSS REFERENCE:
- .:.:: 'Cr
(Z.-1...j'
Signature of Applicant
RECEIVED B Y --r-ci<,._.�� (7 D
TovGn Cler 's Office
DATE: i -� 32-9 / // e--i
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HEALTH SERVICES
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SURVEY FOR U,/jO-xL cet16 6,&'i4
COUNTY DEPARTMENT OF HEALTH SERVICES RONALD BURK 8 VERONICA BURK
APR.8,
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