HomeMy WebLinkAboutDavison, Eugene (2) /0--
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JUDITH T.TERRYo= Town Hall,53095 Main Road
TOWN CLERK Co Z P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ` ��, Southold,New York 11971
MARRIAGE OFFICER :#4 Q� ��� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER : �.� `1►a���� Fax
(516)765-1800
FREEDOM OF INFORMATION OFFICER ,,i"�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1372 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : EUGENE DAVISON
Address 1 : 4300 SOUND AVENUE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW TO AN EXISTING SYSTEM. (WORK BY RAY NINE)
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner DAVISON, EUGENE
Mailing Address 1 4300 SOUND AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 4300 SOUND AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 121 .00 block 3 lot 5.002
Cross Street BERGEN AVENUE
Building Permit Number Cross Reference:
Issue Date: 8/15/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ` o= :.t`‘ Town Hall, 53095 Main Road
TOWN CLERK t H Z , P.O.Box 1179
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REGISTRAR OF VITAL STATISTICS ‘O 0, Southold,New York 11971
MARRIAGE OFFICER .,. 4#4, �� , Fax(516)765-1823
RECORDS MANAGEMENT OFFICER 91 * `1►as,I.
Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER '1%,...;,.. I",
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 15, 1995
Transmitted herewith is a copy of application No. A1425 for a Cesspool/
—foq onstruction Permit submitted by:
Eugene Davison (work by Ray Nine) .
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 `IMON ' ' " I
DISAPPROVE
Comments: —/—.....' -4,.
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Signature "--7‘ :-.11/11
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Dated
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OFFtt AF THE TOWN CLERK ` ""
T est a Southold /7//oLC--
Judith T. Terry, Town Clerk
Town Hall, 5 095 Main Road Construction
P. O. Box 1179 Alteration
Southold, New York 11971
Telephone t
$10.00 - Residential
(516) 765-1801 ' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE
APPLICANT NAME: LSo (f
APPLICANT ADDRESS: 1-1 . 0c23. Sou #Q
it-4-!r1Tb ` C N �{ I S" z
SEPTIC.,, CESSPOOL �C
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: E"1/43G �' � ►4- v1Sc -i
OWNER MAILING ADDRESS: u mac? S o kl (,e-
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OWNER PROPERTY ADDRESS: SMme"
TELEPHONE NUMBER OF CONTACT PERSON: $ Li 6U c.)
TAX MAP NO. : Section /2. 1 Block 3 Lot S.s'
CROSS STREET: -L S- Qf= Rt----2(6 J !1 & S/S SvuvL 1 Ki
BUILDING PERMIT NUMBER CROSS REFERENCE:
0010
IP
Signature of Applican
RECEIVED BY:
Town CI rk's Office
DATE: Cc
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