HomeMy WebLinkAboutEdson, Lewis (3) so''c0FOL/re
JUDITH T. TERRY ` Town Hall, 53095 Main Road
TOWN CLERK O 1-n P.O. Box 1179%
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER V O�' �� Fax (516) 765-1823
,`n411 l �1D ,r� 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. 1092 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ROBINS & SPEED, INC.
Address 1 : P. O. BOX 678
City St Zip GREENPORT NY 11944
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 SEVICES. SCHD REF. #93-SO-81
Name Of Owner EDSON, LEWIS
Mailing Address 1
City St Zip 0000
Property Address 1 CROWN LAND LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 7 lot 11 .000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 2/15/94 Judith T. Terry
Southold Town Clerk
. _ /6
JUDITH T. TERRY :, t L ; Town Hall, 53095 Main Road
TOWN CLERK := o r=r P.O. Box 1179
REGISTRAR OF VITAL STATISTICS y `� ' Southold, New York 11971
MARRIAGE OFFICER
‘VA. aO�'���, Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER =_'�1 4 ��rrl, Telephone (516) 765 1801
FREEDOM OF INFORMATION OFFICER ���,,,i,i,,ir'
OFFICE OF THE TOWN CLERK
Nil 1. a-
TOWN OF SOUTHOLD ,
o I:—
N FEB 2
TO: Southold Town Building Department 'p '
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 1, 1994
Transmitted herewith is a copy of application No. 11Z8 for a Cesspool/
Septic Tank Construction Permit submitted by:
Robins & Speed, Inc. 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
DISAPPROVE
Comments: / 4, I "' ,- -_ -
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Siynature
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Dated
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OFFICE OF THE TOWN CLERK O�0FO'-...CDG
Judith TW Terryn of , thold
Town Clerk
; Application No. / /
Town Hall, 53095 Main Road ' 8 _. Construction 4--
P. O. Box 1179 � � Alteration
Southold, New York 11971 ���-*l ��
Residential
Telephone c._.-
(516) 765-1801
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. /9/4.'5 Cs'"
Fee $/'
DATE 2u O-a7 1 / j`i `j 4--
APPLICANT NAME: Rc NS• SP 1 (NC-
APPLICANT
NCAPPLICANT ADDRESS: -1.).-D . %ai< (P-78`
CQ124v P® /7 (
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/ms's -—(67 7 a d ®F //V Se-PI?G S'ys .ZAr :�ti �t N
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: L. is ac\)
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: C /LO tunl 4A-711/
C 476'
TELEPHONE NUMBER OF CONTACT PERSON: G1-7-7 -VI OA'
TAX MAP NO. : Section / 0.2-- Block 7 Lot /(
CROSS STREET: /vIA/A/ fr?b
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: A///7(..X-4---z_c_<
Town Clerk's Office
DATE: c:V/, /�
SUFFOLK CO.HEALTH DEPT.APPROVAL
wall ---1> H.S. NO.
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••J.4.2 N
c' '. -- O STATEMENT OF INTENT
.,• W r` -- % THE WATER SUPPLY AND SEWAGE DISPOSAL
.t; ,e) ) ' , �� + SYSTEMS FOR THIS RESIDENCE WILL
'r _Bp" _ _ .. 1 CONFORM TO THE STANDARDS OF THE
�J t. f� I/ , _/10 ` J� f / ./ SUF(5L EPTALTH SERVICES.
lam, g �— h O APPLI T _ 6
1111 Z/S o ( c;d R� 7.�a �{£? (
J } +Sl,4Z.•33'SO"L�• 198.84 SUFFOLK COUNTY DEPT. OF HEALTH
1------------ — -- •0 i SERVICES — FOR APPROVAL FOR
e R r • CONSTRUCTION ONLY r
r,..rYB i .1 /V�. /� DATE: 993
M OF L.O ;' NOV 1
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SUFFOLKCO.T X
MAP I
ODESIGNATION:
ar i b 7 Wall CurCH06UE N. Y. DIST. SECT. BLOCK PCL.
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t, - . - do'__-R 1 , p+ { t in{rout—,.j OWNERS ADDRESS:
4 t s LEWIS EDc7 N P, O. BOX 1$1.6
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