HomeMy WebLinkAboutKollen, Joseph 1.
JUDITH T. TERRY Z L . Town Hall, 53095 Main Road
TOWN CLERK : Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS of Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
��� Telephone (516) 765-1801
1 *
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 736 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOSEPH AND SANDRA KOLLEN
Address 1 : P. O. BOX 343
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 6/25/91 .
Name Of Owner KOLLEN, JOSEPH AND SANDRA
Mailing Address 1 P. O. BOX 343
City St Zip SOUTHOLD NY 11971
Property Address 1 TUTHILL ROAD EXT.
HIGHPOINT MEADOWS LOT #46
City St Zip SOUTHOLD NY 11971
Tax Map No. section 55.00 block 6 lot 15.001
Cross Street MOCKINGBIRD LANE
Building Permit Number Cross Reference:
Issue Date: 7/26/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.
733
f ,
Town Hall, 53095 Main Road
^ '4_ - - P.O. Box 1179
-''!1/ Q;d , Southold, New York 11971
JUDITH T.TERRY -,,. ;:-mss TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD D Ce -V.G."
,�tt 15 ,
To: Southold Town Code Enforcement Officer /99,
From: Linda Cooper, Southold Town Clerk's Office r014/2'176-67', �,�,
Dated: July 12, 1991 �'a�r_,�
.,J
Transmitted herewith is a copy of application No. 757 for a Cesspool/
Septic Tank Construction Permit submitted by:
Joseph and Sandra Kollen
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.
ems..
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE oC
DISAPPROVE
Comments: �, „�,..�1,4.„�-' ti ck, ellnOsOk A r A,,�-
t'46t elf pautitl ad.A:PQo . .atQ .:''-
11as--I91
1244CEIVED
Signature
\ ata \c‘l JUL 2619Q1
Dated Town
I,.
`
O?FICEOF THE TOWN CLERK ,c,\FF2Lk 'DTwn ofSouthold )C
Application No. 137JudithTTerry, Town Clerk A .c
Town Hall, 53095 Main Road 81
v;i:: '- Construction
P. O. Box 1179 ` A _ "
Southold, New York 11971 0• Alteration
Telephone 1`91r4[ sa0 Residential
(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
DATE (-- ID - t
APPLICANT NAME: C)O S ipk.„ .gac rtoi ('�c,— V..0 (12 '1
APPLICANT ADDRESS: P -G . _ 343
.So0Ir ( r ) JJ . '`' _ / / 7-7
/
SEPTIC ,--"- CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTER TION
ycicce 77r if-ly
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION Ott ALTERATION:
OWNER OF PROPERTY: d��504_ q ,s,„ ,. /6/60
OWNER MAILING ADDRESS: mow..& �, 0..6c32J-e---
OWNER PROPERTY ADDRESS: Tc) 1( /Z` e -- .
,5001/41140(Ci
TELEPHONE NUMBER OF CONTACT PERSON: 76, S i -7 S'7
TAX MAP NO. : Section 53 Block 6, Lot Wa .
CROSS STREET: 6GC1-11 /1(DC
BUILDING PERMIT NUMBER CROSS REFERENCE:_il /4 Wte4 if ..
Signature of pplicant
RECEIVED BY: X- �
owry Clerk's Office
DATE: ') '/-1, ( '7
P. SUFFOLK CO.HEALTH DEPT.APPROVAL
H.S. NO.
MAP .O" •PRU.PEiZ, *,, y I ,
MncrcIN� Ir• _ SU2VEYEQ forma s''
B 2D LANE f i C. .0
JOS L_� �. say ;--r�o
,�' =t, STATEMENT OF INTENT
r _ ''' a , >;T' - ,A.::,;':(,4, nt THE WATER SUPPLY AND SEWAGE DISPOSAL
4SUUTHOLDii}, . ' SYSTEMS FOR THIS RESIDENCE WILL
TOWN O SOUTHOLD;NY yrs 4,,,,g,„
• CONFORM TO THE STANDARDS OF THE
SUFFOLK CO DEPT. OF HEALTH SERVICES.
(S)
.;� APPLICANT
v ^ r .. -. •
? r ^" / y• � � / �^ SUFFOLK COUNTY DEPT. OF HEALTH
• �-•- _� --'- SERVICES - FOR APPROVAL FOR
>r - M 11, -s•. t,":4",..,'C 'CONSTRUCTION ONLY
. 6-2S-9
Z .'1 Si DATE: 7 -
IN • - J� • H.S.REF.NO.-
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II
' t 1 55 56 E. 180.00 1 B. • ..L p oOC 55 6 PSA r5.1
W OWNERS ADDRESS: •►
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_ _ ›- SOUTHOLD.N.Y I1 71
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