HomeMy WebLinkAboutKirsch, Helen JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK Z.: p r-rt
P.O. Box 1179
tl'3 �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � �`
MARRIAGE OFFICERyQ �- Fax (516) 765-1823
y01 *I'l0 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. 841 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOHN WLATERS
Address 1 : 160A OREGON ROAD
City St Zip CUTCHOGUE NY 11193
Descripton of Proposed Construction or Alteration
REPLACE ROTTED SEPTIC TANK WITH PRECAST TANK.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED. CALL 765-1803,
(BUILDING DEPT. ) FOR AN APPOINTMENT.
Name Of Owner KIRSCH, HELEN
Mailing Address 1 555 PRIVATE ROAD #13
City St Zip SOUTHOLD NY 11971
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Property Address 1 555 PRIVATE ROAD #13
City St Zip SOUTHOLD NY 11971
Tax Map No. section 87.00 block 4 lot 9.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 5/22/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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00 ' = ' i \ MAY 181992
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JUDITH T. TERRY % .. !� L: s' Town Hall, 53095 Main Road
TOWN CLERK Z. G T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Z.
ISI W �, Southold, New York 11971
V� 4� �� Fax (516) 765-1823
MARRIAGE OFFICER 0�,�� Fax
(516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A867 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
JOHN WALTERS FOR HELEN KIRSCH
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
4"-'26 --
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - X
DISAPPROVE -
COMMENTS: . . ' . . I. i •
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V� Date
OFFICE OF THE TOWN CLERK ,R,'""""'
Town of Southold ..'' 'Sv�FUlkc
Judith T. Terry, Town Clerk •" ,%. -• w Application No.
Town Hall, 53095 Main Road ; Z G Construction t�
P. O. Box 1179rri
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Southold, New York 11971 c=1 Alteration
Telephone
.`'O �. � �•, $10.00 - Residential
(516) 765-180101 ��
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' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for101 u�
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CONSTRUCTION or ALTERATION PERMIT 04,
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: ..6-1 0O Lc K-5'L4 jo p
APPLICANT ADDRESS: 5753- }191,- 0lct-c ( P47
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION V' e---#<'c-e--
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: / 537 tA) ((�<c S,4 V-1 Y �I
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OWNER PROPERTY ADDRESS: I . /,3
TELEPHONE NUMBER OF CONTACT PERSON: 73 4,3 9.6(
TAX MAP NO. : Section F-7 Block Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
/nature of Applicant
RECEIVED BY: •
REcemiwn Clerk's Office •
DATE: -
MAY 1 8 199?
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