HomeMy WebLinkAboutBobardiere, Lucille •
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ELIZABETH A. NEVILLE '�`j`O ; Town Hall, 53095 Main Road
TOWN CLERK % p 1 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ‘y- t Southold, New York 11971
MARRIAGE OFFICER . '� 1� Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER **0 4����� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER 1 * `�►••��
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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. 2130 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : HOMEWORKS MODULAR HOMES
Address 1 : C/O SANDRA PELUSO
City St Zip RONKONKOMA NY 11779
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-99-0121
Name Of Owner BOBARDIERE, LUCILLE
Mailing Address 1 19 WILSON STREET
City St Zip MASSAPEQUA PARK NY 11762
Property Address 1 2625 STARS ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 22.00 block 4 lot 3.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 7/29/99 izabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
.. ... 51°43 QEFICFOF THE TOWN CLERK CUFFO(/�'C' Application No
TOWN OF SOUTHOLD fr4
ELIZABETH A.NEVII.I.P,TOWN CLERK �� $10.00 - Residential
P.O.BOX 1179 ,t
$25.00 - Non-Residential
SOUTHOLD,NEW YORK 11971
Telephone Sel * A
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. W5:5—e-
Fee $ 10 ,00
DATE Z5/
OWNER NAME: LUCi 0•C j6-1'dler€ 010 llirk_
OWNER MAILING ADDRESS: let i him
1-lciftpe9cLa PanY , L92--
OWNER
9 -_OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER:
0'1 VO S sS-Y1
TAX MAP NO. : Section o�a Block 4 Lot
-5
CROSS STREET: Plait) d
TYPE OF SYSTEM: Septic Tank New ✓ Existing
Cesspool New I" Existing
Residential ✓ Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Signat r of Appli nt
RECEIVED BY:
Town Clerk's Office
DATE: