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JUDITH T.TERRY , o= Town Hall,53095 Main Road
TOWN CLERK y Z t P.O.Box 1179
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REGISTRAR OF VITAL STATISTICS %O 1�, Southold,New York 11971
MARRIAGE OFFICER y� Q�lei Fax(516)765-1823
RECORDS MANAGEMENT OFFICER *of `�►olo Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER o , • �
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1376 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PARAGON HOME CONSTRUCTION, INC
Address 1 : P. O. BOX 634
City St Zip SHOREHAM NY 11786
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. #R10-94-0121
Name Of Owner EDSON, LEWIS
Mailing Address 1 P. O. BOX 1526
City St Zip SOUTHOLD NY 11971
Property Address 1 CROWN LAND LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 7 lot 6.000
Cross Street SPUR ROAD
Building Permit Number Cross Reference:
Issue Date: 8/23/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ; = c ‘ Town Hall,53095 Main Road
TOWN CLERK %eci3 _ % P.O.Box 1179
REGISTRAR OF VITAL STATISTICS %O ��, Southold,New York 11971
MARRIAGE OFFICER :�.4 Q��r� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER : �.( * *,,d0 Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER •—•._, '•6'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD l't
TO: Southold Town Building Department ()/
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 18, 1995
Transmitted herewith is a copy of application No. 1427 for a Cesspool/
Septic Tank Construction Permit submitted by:
Paragon Home Construction for Lewis Edson .
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 4/°"-
DISAPPROVE
Comments: div- S .ems S al,) itgy, 00-9 5 -O/„2f
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Signature 1
Date•
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OFFICE OF THE TOWN CLERK ,,""
Town of Southold
Application No. / 0. 7
Judith T. Terry, Town Clerk e
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 • _ „.
Alteration
Southold, New York 11971 cri '. :� ���•
Telephone ; O,y� �Q�'*•c $10.00 - Residential 1/
(516) 765-1801 .� ! '
$25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE �� \ C141q �
APPLICANT NAME:?AP, 1:3rJ ��.c-�
APPLICANT ADDRESS: (-23
eSik6iM A-44 v-cam ( ,J
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
)°<`t-t-- SJ
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: "P .0. Gp> t S
, i.)\ . It 4`Z(
OWNER PROPERTY ADDRESS:
s-r? At_Yr, , 7
TELEPHONE NUMBER OF CONTACT PERSON: P4 Z 10 \r,?.
TAX MAP NO. : Section /b, Block -7 LotOCx'C.o��.
CROSS STREET: S jp TZ-c::),40
BUILDING PERMIT NUMBER CROSS REFERENCE:
j / Sig Applicant
RECEIVED
Town lark's Office
DATE: /g-1
i ,_ f .0.:i .•€', SUFFOLK CO. HEALTH DEPT_APPROVAL
�. H.S. NO.
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