HomeMy WebLinkAboutKing, Walter Town Hall, 53095 Main Road
V,'4. � P.O. Box 1179
_ Ol �.a ��� Southold, New York 11971
JUDITH T.TERRY . „���� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 362 R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
PERMIT ISSUED TO:
Name : KING, WALTER J.
Address 1: P.O. BOX 97
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS PER SUFFOLK COUNTY HEALTH DEPARTMENT
APPROVAL.
Name Of Owner KING, WALTER J.
Mailing Address 1 P.O. BOX 97
City St Zip CUTCHOGUE NY 11935
Property Address 1 PINE TREE ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104. 00 block 1 lot 9. 002
Cross Street BAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 6/23/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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\ JUN 2 0 t988Town Hall, 53095 Main Road
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BLDG. DEPT.
OLD "N0I II
JUDrIOWNrOR
OWN LI-RKTELEPHONE
REGISTRAR OF VITAL STATISTICS (516)765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
June 20, 1988
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 364 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Walter J. King
Please review the application and location map and advise if the
project has received Suffolk County Health Department approval
and if we may issue the permit.
Please complete the form below and return it to my office.
Thank you.
•
erdeoed
'6.04 4.04411141014wrammft
Judith T. Terry
Southold Town Clerk
I have reviewed the application and location map of the project
cited above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: ca.„, � c x o cr.., cllCGl„IL 4.1 Ca.,"9,
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OFFICE OF THE TOWN CLERK calf' Wife;
Town of Southold
Application No. .3)' y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Roadcrs+ Construction
P. O. Box 1179 uA 4F$ Alteration
Southold, New York 11971 ,h, �r.
Telephone _0l * �� Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE I°\V‘
APPLICANT NAME: 4
APPLICANT ADDRESS: SkTh v\� y
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: \1
OWNER MAILING ADDRESS: 'S?'0 Zx (l\A
Lv O L, \\ .\/ \\"\1).<
OWNER PROPERTY ADDRESS: S?, ke44 c7
TELEPHONE NUMBER OF CONTACT PERSON: 7 3 (f- 5(, �v Th- S/O
TAX MAP NO. : Section \()4 Block , Lot _V
CROSS STREET: r 1_w CO?
)C1-x ,
BUILDING PERMIT NUMBER CROSS REFERENCE:
c _
ignat re of Appli nt
RECEIVED
n Verk s Office
DATE: JUN 2 0
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• sevji=.ne aicoocal facilities on this pro;e:tt
nave not been verifies'. .
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SUFFOLK CO. HEALTH DEPT. APPROVAL
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STATEMENT OF INTENT
THE WATER SUPPLY AND SEWAGE DISPOSAL
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- / L.. i,.- SYSTEMS FOR THIS RESIDENCE WILL
CONFORM TO THE STANDARDS OF THE
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---------------- ----------- SUFFOLK CO. DEPT. OF HEALTH SERVICES.
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Al. SUFFOLK COUNTY DEPT. OF HEALTH
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SERVICES — FOR APPROVAL OF
__ CONSTRUCTION ONLY
DATE:
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H. S. REF. NC----- 6-' " U /,_-
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SUFFOLK CO. TAX MAP D 'ATION:
DIST. SECT. BLOCK PCL.
1000 104
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7- , OWNERS ADDRESS:
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LIGHT tilt,-comminy.peremmontal aeOngr al
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GUAVEL to the esrionnes of the loads('Mod-
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GUAI2ANTEE0 TO PECONIC le3T12ACT INC,
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LICENSED LAND SURVEYORS
GREENPORT NEW YORK -"So;4 S 256-vike
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