HomeMy WebLinkAboutGristing, Jerome c
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Town Hall, 53095 Main Road
0(10 I P.O. Box 1179
=AO it 0„'0,. Southold,Southold, New York 11971
JUDITH T.TERRY -.,,�'I""'01 FAX 765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 16 N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : FULLER-PERRINE, LAWRENCE
Address 1 : 2540 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR TWO-STORY WINERY BUILDING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES 12/27/88.
Name Of Owner GRISTING, JEROME
Mailing Address 1 26 GLEN EAGLES DRIVE
City St Zip LARCHMONT NY 0000
Property Address 1 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 109.00 block 1 lot 13.000
Cross Street ALVAHS LANE
Building Permit Number Cross Reference: 017716Z
Issue Date: 1/05/89 Judith T. Terry
Southold Town Clerk
__ ___ (TOWN SEAL)
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OFFICE OF THE TOWN CLERK %C\\j"1-A'`,O
Town of Southold ;"1,�, Application No. 4.647
Judith T. Terry, Town Clerk F - reg' ;
Town Hall, 53095 Main Road c ( . s.: 11'6'-1-'i° ' '`
PA � .,1 � Construction
P. O. Box 1179 .•C7- ' Alteration
Southold, New York 11971 4 - . O�
Telephone 'O �� 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. n/e 1
,::,
Fee
$ A� tr''S
DATE /2130/8'$
APPLICANT NAME: I. ai,trehce ru Ile,— Pei"-v i'n €
APPLICANT ADDRESS: 2,5\10 6 -1 rt.4i?C 0 ttDr
Sou 1d , # Jy 11911
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
.J J J
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: (.7-- r-0 rfrte (riS�/'ICI
OWNER MAILING ADDRESS: ,Z (o jlL1
ea) lei TJ v
i___ ✓VL 11/vt 0 rt 1 i / .)y
OWNER PROPERTY ADDRESS: /V1 .;h /d
CL-Fc r!,a y u f , nJ y I ,'7 3 5----
TELEPHONE
`TELEPHONE NUMBER OF CONTACT PERSON.: 5/ 6 - 73(/ 7 O6'9
TAX MAP NO. : Section / 0 y Block 0 / Lot / 3 .
CROSS STREET: fry 1 L s Lin e
BUILDING PERMIT NUMBER CROSS REFERENCE:_ U/ 77 /k Z
j -.--,
Signature of Applicant
RECEIVED B` ED
Town Clerk's Office
DATE: iA.L; ' i 1988
Town Clerk Southold
e
10111111Lss 1111111116 11111.11"
- _iT i.k .3 cad• :
L SUfFOLK COUNTY DEPARTMENT Of HEALTH SERVICES • c .
" APPROVED FOR CONSTRUCTION ONLY :., 6 �: . ..:;
* H.S.REf.NO. Ce0 X S
E7/2 FLOW Y _., s� ,
of TYPE ` F c c �4
'` royal is granted br the constructiotc of the sanitary
This app rsuafl t0 Articles VB and r
s disposal and water supply tecjlities pu , `
7 of the Suttolk County Sanitary Code and is not an expressed y
approval to discharge from or occupy the
t tPnor implied app
structure(s)shown. THIS APPROVALEXP1RES ZWr TMEARS: .§ 4 ' r
LJ. FROM THE DATE BELOW. . LI , �' ,_
3t
71988 ....:;;;y4.1...4.:,....
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