HomeMy WebLinkAboutKoehler, Frederick ,I��,o��g�FFO�,�OG-
JUDITH T.TERRY 1 y< ; Town Hall,53095 Main Road
TOWN CLERK t y Z t P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER 19* Ql��� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER 0.( * `1►is/� Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ••�� ,"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1424 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : WILLIAM POLLINA
Address 1 : P. O. BOX 14
City St Zip NEW SUFFOLK NY 11956
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R-95-0094
Name Of Owner KOEHLER, FREDRICK
Mailing Address 1 10 AZALE COURT
City St Zip FARMINGDALE NY 11735
Property Address 1 NEW SUFFOLK AVENUE
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 6 lot 14.000
Cross Street GRATHWOHL ROAD
Building Permit Number Cross Reference:
Issue Date: 12/07/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY Town Hall,53095 Main Road
TOWN CLERK k H Z I P.O.Box 1179
REGISTRAR OF VITAL STATISTICS �, Southold,New York 11971
MARRIAGE OFFICERs �� 0' Fax(516)765-1823
RECORDS MANAGEMENT OFFICER �.( `�►a�� �� Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ,,'•'�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department 4
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 4, 1995
Transmitted herewith is a copy of application No. 1480 for a Cesspool/
Septic Tank Construction Permit submitted by:
Willia, Pollina for Fredrick Koehler •
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: r'Pi �- 9 te ,l Sc - 9S-461
A/4r ,
Signature
Dated
OFFICE OF THE TOWN CLERK ,,,,,,,,, •
Town of Southold ��',,
Town Clerk �'� �� Application No./f tv
Judith T. Terry, • �,
Town Hall, 53095 Main Road '
Construction
P. 0. Box 1179 •• o •
=` T
Southold, New York 11971 ct� �• Alteration
Telephone
•% 0 i ro• $10.00 - Residential
(516) 765-1801 '��O/ '
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee •$
DATE 4 0(/,
APPLICANT NAME: ZA..); /l/Rh Po///rI/1
APPLICANT ADDRESS: P O d vx
/ 6-L-1 s A 1{Qc� � '� / / 9 S c.
SEPTIC v CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION S,, &
fhb i ,26-StLit.A/cG
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: f/2E.6x( CK /.moo eNc ('
OWNER MAILING ADDRESS: / 0 4 Z,4 [ C
FA-it,I J A/cam ^-27 /i 7J 1
OWNER PROPERTY ADDRESS: it/ S _
TELEPHONE NUMBER OF CONTACT PERSON: pp
TAX MAP NO. : Section // 7 Block (, Lot / c' 1 y
CROSS STREET: ^V.A./ C04,-"6"/1 AL-t-' Su to co cK r4v
BUILDING PERMIT NUMBER CROSS REFERENCE:
6%•J iaa-/Z -
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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_t•12Y1,45 POST N141635
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SUFFOLK CO. HEALTH DEPT. APPR( f
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SUFFOUC 6-4 DEPARTME . 4:— .•<=1
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F. ..'. 1...P RO VAL OF ri)t.ISIFiliCTION OF
:...;......,.E1 FAMiLY i•,'c'S,L,L..:•1,:::E ONLY
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, NO 3 0 1995
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! - n:-)1-1 .:.: fl) 'T-NN.," DATE ... 1.:..' fliz NO. :0••• . #' .tg 1,
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' CONFORM TO THE STANDARDS OF THE '
.
Ar SUFFOLK CO. DEPT. OF HEALTH SERVICES.
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• NEW SU F.F.,..11._kf. ,
' APPLICANT i
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R :::...r.:;,..; *: ! 1,,, L.,:, N.)" SUFFOLK COUNTY DEPT. OF HEALTH
SERVICES - FOR APPROVAL OF
CONSTRUCT ION ONLY
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DATE. . . .
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H. S. REF. NO..
•,, I APPROVED: . •,4
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4.1.........1.81...14 . ',*
SUFFOLK CO. TAX MAP DESIGNATION: - , '
DIST.. SECT. BLOCK ' PCL.
I ' PLEASE NOTE . ,a-x..) 1 ,7 6 • FY014.;..., ' -;
Minimum distance between welt OWNERS ADDRESS: , ' - .• ".1. ",-`4•
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ad cesspool is to be 150 feet
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r1 ATZEA:40;001 S.F.
i DEED; L. --).7 78 P.259 (Q.E F.> '
---- ...._ ! oliZON.PIT'E.
v\i' •-(-.L. ._.f..1. TEST HOLE STAMP
r ,,s . L--1:MON i4;rvil T'-ri
unauthatted afternoon amain . ;
_ ____
to this survey is a violation of :.
r---- i , _ Section 7208 of the New York State
' —
Education taw.
i DATUM.:. 1,4.G.\/. D.
__ _ . __ .. ......_
•
the land surveyor's inked seal or
embossed sof OM not be considered ' ,
to be a valid SW Cat*
.
_ • Guarantees Mead Imam shall run
LOAM only to the mon fandwat IN*navy
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is Premed.and as Ids Wane ihe ' %..,. .1.
! • _ , title company,govenanerad Nancy and ••. ,..'
lending instiutisn Meted boson
. . .
to tne assignees of the lending bad.
l'1AP isimELIDEO- AUG. 4 199S;AuG. 9, ic)9(...-7 tution.Guarantees are not transinable ;
to addsional institutions or subsaquird
owners.
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SEAL ..
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• OF NE ...
- ' ' '....:,:(ZAVEL •''. <• IP,1:-..
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RICK VAILteTU 9d
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LICENSED LAND SURVEYORS , .. •,:i'04,0.LS 2 1,..1Ny .
' • •.. LAND0
0), °'
GREENPORT NEW YORK . ---_,„.....•
----------
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4FO -..
JUDITH T.TERRY /� %� ; Town Hall,53095 Main Road
TOWN CLERK C4 Z P.O.Box 1179
Pit
REGISTRAR OF VITAL STATISTICS � Southold,New York 11971
MARRIAGE OFFICERfl 0'1 Fax(516)765-1823
RECORDS MANAGEMENT OFFICER i �l * `t►assi Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER �.� ,,'•'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 4, 1995
Transmitted herewith is a copy of application No. 1481 for a Cesspool/
Septic Tank Construction Permit submitted by:
Henry Steffens •
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.
�ccG�z�
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments: {ift.e...in 5C/Z — S _ C,07
(9,7X2-41
Signature
Date/ J