HomeMy WebLinkAboutBurkard, Andrew 01 4, 'IA
1 Town Hall, 53095 Main Road
�`�` P.O. Box 1179
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- 1 ��1 Southold, New York 11971
JUDITH T.TERRY -----,A010/001� 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. 487 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : BURKARD, ANDREW M.
Address 1 : 40 SLOCUM AVENUE
City St Zip PORT WASHINGTON NY 11050
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 9/13/88.
Name Of Owner BURKARD, ANDREW AND ANNE B.
Mailing Address 1 40 SLOCUM AVENUE
City St Zip PORT WASHINGTON NY 11050
Property Address 1 UHL LANE
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 5 lot 24.013
Cross Street RYDER FARM LANE
Building Permit Number Cross Reference:
Issue Date: 4/21/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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VI " I Town Hall, 53095 Main Road
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', ►. �` ., . .•�,1 P.O. Box 1179
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JUDITH T.TERRY cc
.04,2401
TOWN CLERK �
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
BLDG DEPT.
To: Victor Lessard, Southold Town Building Department TOWN OF SOv pLD
From: Linda Cooper, Southold Town Clerk's Office
Dated: April 14, 1989
Transmitted herewith is a copy of application No. 498 for a Cesspool/
Septic Tank Construction Permit submitted by:
Andrew and Anne Burkard .
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 reconiRiendations:
APPROVE eC
DISAPPROVE
Comments: a., . AL.,. ati_& vr, ac e.g. .s 9 petj
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\Cark)..4.- cf2;0.......D-
Signature
I-Viii [ 2 c\
Dated
''.-
OFFICE OF THE TOWN CLERK Oc�1FFULIj'
JudithTTwn orry, Town Clerk - �: ef. D�thold
Application y No.'1
Town Hall, 53095 Main Road c 1 - r• '� Construction
vs > 2c
P. O. Box 1179 _ ? ` Alteration
Southold, New York 11971 0�•
Telephone �1 * �� " 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. L1'9-3
Fee $ 10 , L�
DATE A ' '1L 1
APPLICANT NAME: A4O/ f td a <44.O
APPLICANT ADDRESS: 4 • 51-OLfr1
le 14.1th/44-Ad y I 106-0
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTI N OR ALTERATION
U'N(NC,p<
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: A„poR 41* Att)isie I'. al,,4JC,4, 'P
OWNER MAILING ADDRESS: ] d Gum 4
POI-tomit-b4/6-1-AJI I( 1 /017/0
OWNER PROPERTY ADDRESS: j� f L. 1.,9Ne-
440/4-NN"./1/7 /15.01
TELEPHONE NUMBER OF CONTACT PERSON: .138 • 12.64
TAX MAP NO. : Section 6140 Block Lot . 4.„ 13
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CROSS STREET: IN rof-tF L-Aii
BUILDING PERMIT NUMBER CROSS REFERENCE:.
,AL.,/.
Z
Signature of Applicant
RECEIVED BY:
M ion Clerk's Office
DATE:
APR 14
SUFFOLK CO.HEALTH DEPT.APPROVAL
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«jj �:;,;4; r1,1 STATEMENT OF INTENT
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s � _. .____...._.__...___.--_---.._______.__v _ i (!i ' THE WATER SUPPLY AND SEWAGE DISPOSAL
���, �� ! SYSTEMS FOR THIS RESIDENCE WILL
y + • ' v\`vr.Lt/I, i i I c I9 J.r CONFORM TO THE STAND DS OF THE
)-1-1 1 CD I a I .34 S' 989 SUFFOLk CO.J T. -v'• T , -.VICES.
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F4' . APPLICA,0 .l 1 I i 4 9 Sit
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EXCAVATION INSPECTION REQUIRED AQ~ l SUFFOLK COUNTY DEPT. OF HEAL
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-.1 SERVICES — FOR APPROVAL OF
__. {�yt� CONSTRUCTION ONLY
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VAt Pt 4' h APPROVED: _/-3.ii----`
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fr {lj 15 SUFFOLK CO.TAX MAP DESIGNATION:
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1 s DIST SECT. BLOCK PCL.
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Requires septic tank - - . . =
4 tti I (�1 MQNU1MOWNERS ADDRESS:
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