HomeMy WebLinkAboutEdeen, Ronald ,,o��FFo��rCoo
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK Z. p rZ P.O. Box 1179
Z.REGISTRAR OF VITAL STATISTICS • .� � Southold, New York 11971
MARRIAGE OFFICER yQ ��, Fax (516) 765-1823
4#40 ��� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 663 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : RONALD J. EDEEN
Address 1 : P. O. BOX 335
City St Zip EAST MARION NY 11939
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 8/2/90.
Name Of Owner EDEEN, RONALD AND BARBARA
Mailing Address 1 P. O. BOX 335
City St Zip EAST MARION NY 11939
Property Address 1 MAIN ROAD
City St Zip EAST MAR ION NY 11939
Tax Map No. section 31 .00 block 4 lot 32.000
Cross Street TRUMAN'S PATH
Building Permit Number Cross Reference:
Issue Date: 11/20/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I
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cr v > .� Town Hall, 53095 Main Road
`iQc. �- ���� P.O. Box 1179
01 ;b �`it o$ Southold, New York 11971
JUDITH T.TERRY =ut...,,,,,,,,i- TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: November 14, 1990
Transmitted herewith is a copy of application No. 679 for a Cesspool/
Septic Tank Construction Permit submitted by:
Ronald and Barbara Edeen .
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.
, a.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE b
DISAPPROVE (�
Comments: a-. 1.",. ......c.. .4i^n Q11g9,
t/1171` 1 9- c-t� '4-
0 r.o.,.e11 S.C. Ak Nst.ter M $\i\al0
\C:c..1.4.07LcQ—
Signature
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Dated
OFFICe OF THE TOWN CLERKSF�6-
Town of Southold �% Ca
,J y Application No. (o
Judith T. Terry, Town Clerk ='"1
Town Hall, 53095 Main Road c !•� : i ?}. 'FT—� Construction
P. O. Box 1179 cn �'
O. '� Alteration
Southold, New York 11971 �-
Telephone r [ �► 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 $
DATE
APPLICANT NAME: 0 L
APPLICANT ADDRESS: R,41AJ 87,4_,z)
& '457--ti(44Vo AI A/,yrily,37
SEPTIC CESSPOOL
DESCRIPTION OF PROPOS D CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 'ROkAtj' 4. /
OWNER MAILING ADDRESS: p-.O, -Roe335—" �!
A A '.a. Oma. •
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: -477— l5 f
TAX MAP NO. : Section 3 1 Block T Lot 3 •
a-
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:_.
Sig /pure of Applicant
RECEIVED BY: (/( A-C-'/A
/o Clerk's Office
DATE: ///1(1 /90 y0
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SUFFOLK CO. HEALTH DEPT. APPROVAL.
H. NO. • ''
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^ ED' .EY —
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t a �fi Tom, STATEMENT OF INTENT
.. ' . THE WATER SUPPLY AND SEWAGE DISPOSAL
eisr IZ }:; SYSTEMS FOR THIS RESIDENCE WILL', ..-
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_ SUFFOLK • /*EPS . O,H • L H SERVICE
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r' CONSTRUCTION ONLY
DATE:•
H. S. REF, NO.: •
APPROVED:
SUFFOLK CO. TAX MAP DESIGNATION:
DIST. . SECT. BLOCK PCL.,
.IO 031_ . 4 . , :32
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OWNERS ADDRESS:
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ENT OF HEALTH SERVICES +► tending:9,Tho. jL--
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