HomeMy WebLinkAboutJavaheri 6 Town Hall, 53095 Main Road
P.O. Box 1179
o �"0 Southold, New York 11971
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TELEPHONE
JUDITH T.TERRY -.
TOWN CLERK (516)765-1801
REGISTRAR OE VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 379 R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
PERMIT ISSUED TO:
Name JAVAHERI, KOUROSH
Address 1: 43 WINDSOR ROAD
City St Zip GREAT NECK NY 11021
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY HEALTH
DEPARTMENT 1/4/88.
Name Of Owner JAVAHERI, KOUROSH
Mailing Address 1 43 WINDSOR ROAD
City St Zip GREAT NECK NY 11021
Property Address 1 COUNTRY CLUB DRIVE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 109. 00 block 3 lot 2.032
Cross Street LINDEN AVENUE
Building Permit Number Cross Reference:
Issue Date: 8/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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Town
BL.DG.DEFT. �' B 1179 Road
Hall, 53095 Main
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JUDIT ' ERRY r
TOWN CLERK ~4"04•0/// °4110
TELEPHONE
REGISTRAR OF VITAL STATISTICS (516)765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda. Cooper, Southold Town Clerk's Office
Dated: July 25, 1988
Transmitted herewith is a copy of application No. 384 for a Cesspool/
Septic Tank Construction Permit submitted by:
Kourosh Javaheri
•
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: o,„ L MaoLuml qTrrou.s.S_
\)ir
Signature
7/ 4/ 28
Dated
II
OFFICE OF THE TOWN CLERK c;�:�FDL
Town of Southold V C� �[
Judith T. Terry Town Clerk P ' Application No.
5, tis �G
Town Hall 53095 Main Road o �^�� • �� ��� -q-
Construction
P. O. Box 1179 �. '
Southold, New York 11971 � , Alteration
Tele hone �l 44'� . Residential
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(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 $ /Q,, 61"e'
DATE
7/- -0?
APPLICANT NAME: 1-1 /A-1/4/ 6-4-
APPLICANT
- -APPLICANT ADDRESS: (73 CJ/.✓2so/L /c`.
C,e Ek4j /7CIC A/7 // >--
SEPTIC CESSPOOL
•
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: �Z o S/-i JA"(44/46
OWNER MAILING ADDRESS: O 111/„0s OX lL�
6 )2 C NEcx- //7(2)-/
. OWNER PROPERTY ADDRESS: /75
TELEPHONE NUMBER OF CONTACT PERSON: -yo----31/—V-a,
TAX MAP NO. : Section /U 1 Block 3 3--3) Lot 9/
CROSS STREET: C1OOAtri? C-1-tity
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Signature` , Applicant
RECEIVED BY: _ _/ , AV_
o. n C -rk s •ffice
DATE: 7- r•
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SUFFOLK COUNTY N i A'TMFNT OF Hi LTH SERVICES
FC r: Ar:RCVFL CF COP`•ST?.!JCTfC•N CNLY
SURVEY OF
DATE ti`! ( I.: i _. I:C� o ? S N) .-
LOT II The water disposal
supply &sewage fDM/al sys-
tems for this residenceewillnn,i • /,_/
standards of the Suffolk Co, t' APPROVED !�/J
MAP OF ment of H ah Server-/ _,
TR Yr, CLUB ESTATES TES ��'f`/ �/�� , ". C n rill Y ;',,v �t_!; j ONLY
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COON _ _ ..
FILED OCT. 17 1978 FILE NO. 6736 { S�-�—clitir , '''''sS''. - t r n
' -,Dip,__ I�rlj�i 1�i. 1'��.la`� i':::i:r'I l:ii�:: �,•:- :h.i's1''�tGV�•'t M
AT CUTCHOGUE 1 E125&L �A-kHA Ei=
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TOWN OF SOUTHOLD 2�}3 �, 14 s� . S, ��
•
SUFFOLK COUNTY, N.Y. Y
1000 - 109 - 03 - 2.32 �P� I l<, ti. (Uoa3
DEC 3 1987
Scale l' = 40' •
Nov. 2, 1987 �qv AND s, SC DEPT OF
-_.�d........_ - ,_. t 4..e.x�NGF.,,,l eaAlTH SERVICES