HomeMy WebLinkAboutDavis, Mark „ ,,,,III,'
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JUDITH T. TERRY • .rC ; Town Hall, 53095 Main Road
TOWN CLERK : p
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P.O. Box 1 179
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REGISTRAR OF VITAL STATISTICS Southold, New York 11971
. ��� Fax 516 765-1823
MARRIAGE OFFICER ���0 1o"���� Telephone (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. 853 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : LISA AND MARK DAVIS
Address 1 : P. O. BOX 1493
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 3/22/92.
Name Of Owner DAVIS, MARK
Mailing Address 1 P. O. BOX 1493
City St Zip MATTITUCK NY 11952
Property Address 1 A.J. MASTERS ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 126.00 block 9 lot 26.003
Cross Street PECONIC BAY BLVD.
Building Permit Number Cross Reference:
Issue Date: 6/19/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY L ; Town Hall, 53095 Main Road
TOWN CLERK z. rZ P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS irS Southold, New York 11971
MARRIAGE OFFICER `Oao,�� 3
�� �selFax� Telephone (516)6) 5-18 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
JUN - 8r92
DATED: June 8, 1992
Transmitted herewith is a copy of application No. 877 for a Cesspool/
Septic Tank Construction Permit submitted by:
Lisa and Mark Davis •
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 recommendations:
APPROVE
DISAPPROVE
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Comments: o,. .w,,at,ca kL ev, caTem- of %wt.LAti 6144.49
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JUN 171992
_ sow Signature
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Dated
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OFFICES OF THE TOWN CLERK �FFfl
eco
Town of Southold
Town Clerk ', : R k G Application No. x'17
Judith T. Terry,
Town Hall, 53095 Main RoadConstruction v
P. O. Box 1179 n r i
Southold, New York 11971 Dd � � Alteration ��
Telephone 1 [ 0 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. 7 7
Fee .$ /0
DATE J(,L,,-t,, e, (Q9
APPLICANT NAME: L/51'4 ¢ /n(},e/Z DA:/lS
APPLICANT ADDRESS: ?.O . BOX /6/9_3
//l T/rueR N I/qS,2
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Si Al/t P714 iLy Dmi014N6
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: MARK tD A-1 t5
OWNER MAILING ADDRESS: V p. /3ex /Y?3
/ViA-7-T/ c,t4 ,v y /l 9s a
OWNER PROPERTY ADDRESS: A 4, /11,4 - 5 Ipni f ck' /y
119.f.2
TELEPHONE NUMBER OF CONTACT PERSON:($-/&) <A9T-$'59 2
TAX MAP NO. : Section /c/4 Block p ( Lot/P-624:..3 + % __
CROSS STREET: p co N t c; 181- QL
BUILDING PERMIT NUMBER CROSS REFERENCE:_
d4Cet. L2-
Signature of Applicant
RECEIVED BY: /4 /
t,th-r-tr
own Clerk's O 'ce
DATE: 0/Cr-
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EXCAVATION INSPECTION RE \\ GAIG,A ,
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SUFFOLK COUNTY DEPARTMENT OF rEALTH SERVICES '
FOR AOROVAL OF CONSTRUCTION ONLY • .
1AR 2 31992 x NO.Cr 1 i- The water lady and**wag*disposal �1
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