HomeMy WebLinkAboutBurke, Thomas ,,,,,,,,,..,,,,
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Town Hall, 53095 Main Road
JUDITH T. TERRY
TOWN CLERK ,1 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS :CP ���` Southold, New York 11971
Fax (516) 765 1823
MARRIAGE OFFICER D 0�,�� Tel (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 807 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : CHARLES ALLEN CONSTRUCTION MGT
Address 1 : P. O. BOX 31
City St Zip LAUREL NY 11948
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITEED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 6/27/91 .
Name Of Owner BURKE, THOMAS
Mailing Address 1
City St Zip 0000
Property Address 1 1570 BRAY AVENUE
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 7 lot 26.001
Cross Street FOURTH STREET
Building Permit Number Cross Reference:
Issue Date: 2/26/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY •�, . Town Hall, 53095 Main Road
TOWN CLERK v P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER V� Fax (516) 765-1823
D,y� ��Q�'�� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: February 14, 1992
Transmitted herewith is a copy of application No. 828 for a Cesspool/
Septic Tank Construction Permit submitted by:
Charles Allaen Construction Mgt. for Thomas Burke
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 recomm ndations:
APPROVE
DISAPPROVE
Comments:
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RECEIVED
1 41<.0".7/ —
fi ) Signature
FEB FEB 2 � 1..9. ��
41 aCI ted
OFFICE OF THE TOWN CLERK ,,,'",,,"''
Town of Southold .''�.C,� fULA'C',
pp
�' Q �G Application
�
Judith T. Terry, Town Clerk �, :
Town Hall, 53095 Main Road ;� Construction
P. O. Box 1179 rn ; Alteration
Southold, New York 11971 tris
Telephone y0 �Q�i� $10.00 - Residential
(516) 765-1801 -_ "L l , " $25.00 - Non-Residential
....,.,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION <::
for RICSIVID
CONSTRUCTION or ALTERATION PERMIT FEB 14
SEPTIC TANK or CESSPOOL town
Clot
Permit No.
Fee $ AO
DATE
APPLICANT NAME: 0741i2/ l4 L CCP C 4 NS ia_U C-T1 o til M 6
APPLICANT ADDRESS: PCS . j X 3
L f4✓f� Ce �? y. l l q t,
SEPTIC I CESSPOOL J l
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: J f{by-iIftS I3Ua.�
OWNER MAILING ADDRESS: (5-10 c3 /WE
L_AUPtL Iy icpzis
OWNER PROPERTY ADDRESS: 5"79KE-
TELEPHONE NUMBER OF CONTACT PERSON: Z l.c65 l��
TAX MAP NO. : Section 0'696 Block CZ-6 Lot
CROSS STREET: {t\I �(
BUILDING PERMIT NUMBER CROSS REFERENCE:
1 .Q11
Signature of pplicant
RECEIVED BY: / ► ��
own Clerk's Office
DATE: 47/4-\--t..-
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