HomeMy WebLinkAboutKline, George •
OFFICE OF THE TOWN CLERK cvFFO(K�,
Town of Southold \)
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179 `
Southold, New York 11971 �y� �0�.
Telephone Ol Alt r „
(516) 765-1801 '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 208 Residential X
_
Non-Residential
Fee $ 10.00
Septic Cesspool x
PERMIT ISSUED TO:
NAME: Boeckman Construction Corp,
ADDRESS: Box 1453
Mattituck, New York 11952
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling with Sanitary System
APPROVED as submitted
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: George Kline and Harold Clark
OWNER MAILING ADDRESS: 3 Celano Lane
West Islip, New York 11796
OWNER PROPERTY ADDRESS: Mill Road
Mattituck, New York
TAX MAP NO. : Section 106 Block 9 Lot p/o 8
CROSS STREET: Bayview Avneue
BUILDING PERMIT NUMBER CROSS REFERENCE:
Ju ith T. Terr
Southold Town Clerk
DATE : July 29, 1987
(TOWN, SEAL)
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OFFICE THE TOWN CLERKS�FFOCK
Town of Southold :CDS Application
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction 7-
P.
P. O. Box 1179 � Alteration
Southold, New York 11971
Telephone0l [ � ; Residential V
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. Q�O
Fee $ / 40.
O O
DATE
APPLICANT NAME: ;144tacr.1 Go),A C-4SQQ
APPLICANT ADDRESS: (453
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
AAS
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION
OWNER OF PROPERTY: �Q f�.L4,l� 1 Go CL
OWNER MAILING ADDRESS: d L,4
(Ai . _L Ca? //V'
OWNER PROPERTY ADDRESS: A/k.L. O,qp MATTI-Ts-3 CAL
TELEPHONE NUMBER OF CONTACT PERSON: Z,9 6- sBil
TAX MAP NO. : Section /C7(41 Block Lot P/0 S
CROSS STREET: Aj (J( AA--
BUILDING
--BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY :
Town Clerk's Office
DATE:
At,
, SUFFOLK CO. HEALTH DEPT. APPROVAL
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0 < Com- ; n I STATEMENT OF_INTENT
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DATUM : MEAN 45E/4 LENi,.•�.. :,'',4'44-`,.006t4 GREENPORT NEW YORK
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