HomeMy WebLinkAboutCornell, Clifford III oicsVFOUr
ELIZABETH A. NEVILLE ��a� * ; Town Hall, 53095 Main Road
TOWN CLERK ; H ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER `Lyflpl �►aO�,e,, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,9��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2345 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CLIFFORD CORNELL III
Address 1 : 22 WRIGHT ROAD
City St Zip ROCKVILLE CENTRE NY 11570
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 #R10-00-0014
Name Of Owner CORNELL III, CLIFFORD
Mailing Address 1 22 WRIGHT ROAD
City St Zip ROCKVILLE CENTRE NY 11570
Property Address 1 1140 HOMESTEAD WAY
City St Zip GREENPORT NY 11944
Tax Map No. section 33.00 block 3 lot 15.000
Cross Street MOORES LANE NORTH
Building Permit Number Cross Reference:
Issue Date: 6/14/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ����=0 ' : Town Hall, 53095 Main Road
TOWN CLERK o - % P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS v' 47 i! Southold, New York 11971
�� Fax(631) 765-6145
MARRIAGE OFFICER `�y toN./ Tele hone (631) 765-1800
RECORDS MANAGEMENT OFFICER ;_44 �a P
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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: June 14, 2000
Transmitted herewith is a copy of application No. 2483 for a Cesspool/
Septic Tank Construction Permit submitted by: -
Clifford Cornell III .
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:
12.4.4-&.....al 61%.,
ignature
.6/44/00
Dated
OFFICE OF THE TOWN CLERK ,,,'"""'
' Town of Southold ��''�� In `—.
Judith T. Terry, Town Clerk ��' �� 4t,--. Application No.'� y q 9
Town Hall, 53095 Main Road ;� Construction t
P. O. Box 1179 . = rn ;
Southold, New York 11971 . t11 r •• Alteration
Telephone `y�,y't� -0
' sr $10.00 - Residential L�
(516) 765-1801 - 1
d�r $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 June 14, 2000
APPLICANT NAME: Clifford Cornell III
APPLICANT ADDRESS: 22 Wright Road
Rockville Centre, NY 11570
SEPTIC x CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
New system
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Clifford Cornell III
OWNER MAILING ADDRESS: As above
OWNER PROPERTY ADDRESS: 1140 Homestead Way
Greenport
TELEPHONE NUMBER OF CONTACT PERSON: 631-734-5800
TAX MAP NO. : Section 33 Block 3 Lot 15
CROSS STREET: Moores Lane North
BUILDING PERMIT NUMBER CROSS REFERENCE:
# •
/- / j / Signature of, . ppli ,nt
RECEIVED BY : /`- /
Town Clerk's ice
j
DATE: 1 4 ,// " ,
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_ numFOR APPROVAL OF CONSTRUCTION FOR A
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0SINGLE FAMILY RESIDENCE ONLY
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