HomeMy WebLinkAboutButler, Richard i
"$10�\�FFULIr1 �_
Town Hall, 53095 Main Road PR 1
w � P.O. Box 1 179
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•• Southold, New York 11971
JUDITH T.TERRY __ Oi * $ ••'0TELEPHONE
TOWN CLERK '.00ii//011I (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. 393 R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
PERMIT ISSUED TO:
Name : GEIDEMAN, JOHN H.
Address 1: P. O. BOX 416
City St Zip EAST MARION NY 11939
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED.
Name Of Owner BUTLER, RICHARD
Mailing Address 1 496 GRAPHIC BLVD.
City St Zip NEW MILFORD NJ 07646
Property Address 1 ROW OFF MANHANSET AVE
City St Zip GREENPORT NY 11944
Tax Map No. section 36. 00 block 2 lot 23 . 004
Cross Street ANGLERS LANE
Building Permit Number Cross Reference:
Issue Date: 9/02/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK Ss Mu('
Town of Southold 0�\ COl/
Judith T. Terry, Town Clerk Application No. 3 y7
Town Hall, 53095 Main Road Construction
P. O. Box 1179 � J Alteration
Southold, New York 11971
t"
Telephone 1/ [ 'j 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 $ /D /
DATE F7' /a'P
APPLICANT NAME: 4,4n 6, ernavi J
APPLICANT ADDRESS: a/9,--eV / eS / #G/, ^40, /vim d..1/
F. 1vl .r, r1 /\t '
SEPTIC CESSPOOL ✓ /
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/` �c1syr�/c. f� $' _ �raryi c� Qtve /X
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:pp
OWNER OF PROPERTY: /t-ic/arc/ 13v��e�-'
OWNER MAILING ADDRESS: Cj 63rea i .0 6/1/d,
A/e,v M/ ,zt /At J, P7
OWNER PROPERTY ADDRESS: /' O, GU", cif:6 )7anh ,7 Serf-
TELEPHONE NUMBER OF CONTACT PERSON: q/cf- 6S-oO
TAX MAP NO. : Section Block 2 Lot 2 3. 174
CROSS STREET: /�' /IWQ,?hv�Sc,`" re•
BUILDING PERMIT NUMBER CROSS REFERENCE:
R •
Signature of Applicant
RECEIVED BY: .-ot.c......�
Town Clerk's fice
DATE: RECEIVED
0 21988 •
Town Clerk Southold
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