HomeMy WebLinkAboutHokanson, Richard (2) ,,/gyp
ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �'�� Southold, New York 11971
MARRIAGE OFFICER .f� .! Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ��� .������� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER '',,0'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2469 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : RICHARD HOKANSON
Address 1 : 40 JOMAN ROAD
City St Zip SHOREHAM NY 11786
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF # R10-00-0176
Name Of Owner HOKANSON, RICHARD
Mailing Address 1 40 JOMAN ROAD
City St Zip SHOREHAM NY 11786
Property Address 1 1635 NOKOMIS ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 3 lot 33.000
Cross Street HIAWATHA'S PATH
Building Permit Number Cross Reference:
Issue Date: 11/20/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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7
ELIZABETH A. NEVILLE "_ y1 Town Hall, 53095 Main Road
TOWN CLERK ; h P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � "7 $ Southold, New York 11971
MARRIAGE OFFICER � 1i s. Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER --749.1_212 ,a°,',� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ''��a"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 17, 2000
Transmitted herewith is a copy of application No. 2557 for a Cesspool/Septic Tank Construction
Permit submitted by:
Richard M Hokanson
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
ignatur
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Dated
C-
OFl�10E OF THE TOWN CLERIC
el SIM
TOWN OF SOUTHOLD �;'_Q�S�FF�IKoI Application No.
.I.I7A.NEVII E TOWN CLERK441
V G 7
F ABETH 0 '�►
P.O.BOX 1179 %a Z; Construction
SOUTHOLD,NEW YORK 11971 : P T
tri i . Alteration
Telephone `•,j0,j� �iri • $10.00 -Residential ----
(631)
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(631) 765-1800 = �l. i �,.''� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
? ECElVED
APPLICATION NOV 1 7 2000
for sourhouw town aerk
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE ////7 2`7''`�
APPLICANT NAME: / 4' 70/.0,`"/..5 A✓
APPLICANT ADDRESS: 7 _)op it / -
ShO Lh14 ,‘"/r //9
SEPTIC k/ CESSPOOL
DESCRIPTION,OF POSED CONSTRUCTION OR ALTERATION
-DLOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST UCTIO OR AWERATION:
OWNER OF PROPERTY: /fd1c/ 7
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OWNER MAILING ADDRESS: ( v :31j,./4ti /`4
51 riI4,. <4' //7c1C
OWNER PROPERTY ADDRESS: %631 No/(on ;) 4'
TELEPHONE NUMBER OF CONTACT PERSON: G3 1 '2 1- 11/
TAX MAP NO. : a tion 7 Block 3 Lot
CROSS STREET: 0,3...9J �-0
BUILDING PERMIT NUMBER CROSS REFERENCE:
//7-74.---------•
Signature of Applicant
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RECEIVED BY 1 -,
Town Clerk's Office
DATE:
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