HomeMy WebLinkAboutDuerwald, Andrew ` ,, /OO`UFF0��
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JUDITH T.TERRY `II o= d • Town Hall,53095 Main Road
TOWN CLERK v3 Z P.O.Box 1179
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REGISTRAR OF VITAL STATISTICS Oy Southold,New York 11971
� Fax(516)765-1823
MARRIAGE OFFICER �fO At"
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RECORDS MANAGEMENT OFFICER .� 41g '► oe° Telephone(516)765-1800
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. 1422 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN BERTANI BUILDER INC.
Address 1 : 1380 OAKWOOD DRIVE
City St Zip SOUTHOLD NY 11971
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. SCHD REF. #R10-95-0100
Name Of Owner DUERWALD, ANDREW AND MARGARET
Mailing Address 1 P. O. BOX 494
City St Zip SOUTHOLD NY 11971
Property Address 1 1450 THREE WATERS LANE
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 3 lot 19.000
Cross Street SOUNDVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 12/07/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �'� .r4 Town Hall,53095 Main Road
TOWN CLERK y Z P.O.Box 1179
REGISTRAR OF VITAL STATISTICS �I Southold,New York 11971
MARRIAGE OFFICER Wie 0 I' Fax(516)765-1823
RECORDS MANAGEMENT OFFICER �.( ` •,i Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER -.. ,,, ,,s '
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 27, 1995
Transmitted herewith is a copy of application No. 1477 for a Cesspool/
Septic Tank Construction Permit submitted by:
John Bertani Builder for Andrew and Margaret Duerwald •
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
Comments: y_ea„-- S
Sig a t reo
Date
p 1
OFFICE OF THE TOWN CLERK c3VFF0Lt
Town of Southold
r Town Clerk Dy Application No./ 4/ 77
Judith T. Terry,
Town Hall, 53095 Main Road Construction
P. O. Box 1179Alteration
cn
Southold, New York 11971
0 fit '$ Residential
Telephone - 1
(516) 765-1801
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: p�n njefn (3u-klder Tn�
APPLICANT ADDRESS: j Sit) On .unGoa Or.
c�vLl`I9 o I�- _Nt 1V171
SEPTIC / CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
CUYld fu to r� 0A' 0 fNe.. ►1 d tird t n
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 6. rt{,,-3 OLN mrf,ck�.+ Oue,(ani
OWNER MAILING ADDRESS: P . 0 . (34 �J
ouL o\ N� 11gl 1
OWNER PROPERTY ADDRESS: \L1S1) ree_, WOjefj [ �
Orker+, IL( Ilg.0
TELEPHONE NUMBER OF CONTACT PERSON: -76S--1 Cc(
TAX MAP NO. : Section Ma& Block 03 Lot 19
CROSS STREET: SoLLadjv1-cc.0 l A)
BUILDING PERMIT NUMBER CROSS REFERENCE:
CtAdCA- J.. -
Signature of Applicant
RECEIVED BY:
Towq,keeitiraice
DATE: !''��
NOV 2 7 1995
•
Tarn Clerk Scwthold
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