HomeMy WebLinkAboutDilworth, Theresa �#
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JUDITH T.TERRY ` o= • Town Hall,53095 Main Road
TOWN CLERK Z P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ` �, �1 Fax(516)765-1823
RECORDS MANAGEMENT OFFICER
MARRIAGE OFFICER * %e Telephone(516)765-1800
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FREEDOM OF INFORMATION OFFICER ., •, ,•��'�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1206 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MARTZ, THEODORE C JR.
Address 1 : 145 RYERSON AVENUE
City St Zip MANORVILLE NY 11949
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY
DEPARTMENT OF HEALTH SERVICES.
Name Of Owner DILWORTH, THERESA
Mailing Address 1 310 EAST 55TH STREET, APT. 12E
City St Zip NEW YORK NY 10022
Property Address 1 SOUND AVNEUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 112.00 block 1 lot 8.005
Cross Street BERGEN AVENUE
Building Permit Number Cross Reference:
Issue Date: 9/15/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY Z . . Town Hall, 53095 Main Road
TOWN CLERK : c= T P.O. Box 1179
is Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = �� �. •'1 Fax (516) 765-1823
MARRIAGE OFFICER .p///�� .aO r' Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER '_''U 4 rr
FREEDOM OF INFORMATION OFFICER ��,,i.i,�,rrr
OFFICE OF THE TOWN CLERK i D 1E Q ff Q 1 ff r
TOWN OF SOUTHOLD
TO: Southold Town Building Department 2 'Ogq P
FROM: Linda Cooper, Southold Town Clerk's Office k--
Bc5DATED: rnw,,L :it,,o T.
September 12, 1994 n__,h,,_: .. 7o„,, Os
Transmitted herewith is a copy of application No. 1251 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Theodore C. Martz Jr. for Theresa Dilworth
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: � i Se4/D
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OFFICE OF THE TOWN CLERK �c�VFFair„-- _
Ton of Southold
Judith T. Terry, Town Clerk I 4,* Application No./ S-/
Town Hall, 53095 Main Road est;:`_` : Construction v�P. O. Box 1179 �
Southold, New York 11971
O + ' • Alteration
Telephone i s [ N 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 $ -_
q/1./q(c•
c..yDF_____>______
APPLICANT NAME: C/2.- \-4e•
APPLICANT ADDRESS: / A&
61ev,; 4i lq'Y-q
SEPTIC CESSPOOL /
DESCRIPTION OF
PROPOSE ONSTRU TION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTR CT ION O A TERATION:
OWNER OF PROPERTY: ./ e4 i (ooe//4.
OWNER MAILING ADDRESS: 3/O S "�' 4f.
)00.0./, ( Via0 I ' /�p2 -
OWNER PROPERTY ADDRESS: d�
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TELEPHONE NUMBER OF CONTACT PERS N: ._ 828. eV-glis
TAX MAP NO. : Section /12- Block Of Lot 8.S
CROSS STREET: t.\\_.6-----
BUILDING PERMIT NUMBER CROSS REFERENCE:
-
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I a :� ^'!. / ,i IRIS /
,// // Signature of ' pplica
RECEIVED BY: /b�,
Town Clerk's ffice
DATE: 9// __./ 'V
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PLEASE NOTF
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