HomeMy WebLinkAboutVan Duzer, Chuck •,ogipOFFO(,rco
ELIZABETH A.NEVILLE , ,Z GtiTown Hall, 53095 Main Road
TOWN CLERK t c 1� P.O. Box 1179
c4 rri21 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS :�
MARRIAGE OFFICER Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER y �� Telephone (516) 765-1800
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FREEDOM OF INFORMATION OFFICER =��� 11/:'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 87 N Residential Non-Residential X
Fee $ 25.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CHUCK VAN DUZER
Address 1 : PO BOX 16
City St Zip PECONIC NY 11958
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR COMMERCIAL BUILDING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #C10-98-19
Name Of Owner CHUCK VAN DUZER
Mailing Address 1 PO BOX 16
City St Zip PECONIC NY 11958
Property Address 1 37300 MAIN ROAD
City St Zip PECONIC NY 11958
Tax Map No. section 85.00 block 3 lot 5.010
Cross Street SKUNK LANE
Building Permit Number Cross Reference:
Issue Date: 2/18/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE t 1V C�* ; Town Hall, 53095 Main Road
TOWN CLERK % = . , P.O. Box 1179
•k y Z 4 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �O Pry
MRIAGE OFFICER0
4 Fax (516)765-1823
RECORDS�MANAGEMENT OFFICER `.of �1111 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER °I iNg a011
F 7 -A)
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 5, 1999
Transmitted herewith is a copy of application No. zogir for a Cesspool/
Septic Tank Construction Permit submitted by:
Chuck Van Duzer
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
/p commendations:
APPROVE .
DISAPPROVE
Comments: 9gnatur
...1.-( 5- / cq
Dated
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OFF�ICEOFTHE TOWN CLERK cjjFUL4` Application No.dZoc�,
` TOWN OF SOUTHOLD �►
ELIZABETH A.NEVILLE,TOWN CLERK .L $10.00 - Residential
P.O.BOX 1179 0 �, �� $25.00 - Non-Residential
SOUTHOLD,NEWYORK 11971
Telephone :�.� * 0)-1...1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
coulziz
OPERATION PERM-1-T
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 51" ? 9
OWNER NAME: C/1V('K U 1/U Ouee2
OWNER MAILING ADDRESS: PO G y l(:
peccurc ,v� 1 1'75-8
OWNER PROPERTY ADDRESS: 373G0 )44rti /v40
Pe(1&&V t c rV 096'8
OWNER TELEPHONE NUMBER: 7 3q 7 3 'J
TAX MAP NO. : Section I Fs Block g 3 Lot Is-a,
CROSS STREET: S'"61,,u/C Cit _
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
6741 Laped
Signature of A. • icant
RECEIVED BY: /1/
Town
Clerk's ce
DATE: a/ 5 90p
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LOT COVERAGE
LANDSCAPED = 13%
SUFFOUC COUNTY DEPARTMENT OP HEALTH SERVICES
P:-3P;I:CI:ON REQUIRED
APPROISO FOR CONSTRUCTION, ONLY
EYSTEM
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Meant* show. THIS APPROWL EXPIRES THREE (3)
YEARS FROM THE - • .
FEB 01 1999 %lir • ir
ONE SIGNATURE
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PLAN OF PROPERTY
AT PECONIC
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NY
WO - 85 03 51
SCALE- 1" = 20'
MAR. 30, 1998
NOV. /2, /998 ( sep1k design )
lion. 22, 1999 (revised)
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