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ELIZABETH A. NEVILLE ,�� *0 G •
y�; Town Hall, 53095 Main Road
TOWN CLERK C P.O. Box 1179
W Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `py v�,,�� Fax(631) 765-6145
MARRIAGE OFFICER tel,
RECORDS MANAGEMENT OFFICER � '/Ql $'�1' Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER _ -w ,►��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2346 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN L HURTADO SR.
Address 1 : PO BOX 1925
City St Zip SOUTHOLD NY 11971
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 #R10-99-0193
Name Of Owner HURTADO, JOHN L SR.
Mailing Address 1 PO BOX 1925
City St Zip SOUTHOLD NY 11971
Property Address 1 10995 NORTH BAYV I EW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 5 lot 20.006
Cross Street REYDON DRIVE
Building Permit Number Cross Reference:
Issue Date: 6/20/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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,, OFFoU-4o: JUN 192000 ,X
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ELIZABETH A. NEVILLE �s
_ �• 7.'o Hall, 53095 Main Road
TOWN CLERK ` o Pia Box 1179
L' ,J DEPT.
REGISTRAR OF VITAL STATISTICS v' ':Jb� +yr SOUTHOSButho1 , New York 11971
MARRIAGE OFFICER :se �W���4 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � �Q! .4 �1� Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER W'OP°���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 19, 2000
Transmitted herewith is a copy of application No. 2434 for a Cesspool/
Septic Tank Construction Permit submitted by:
John L. Hurtado, Sr.
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:
ignature
Dated
1
OFFICE OF THE TOWN CLERK 0°.,cAV0L/M/�
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: Application No4feTOWN OFSOUTHOLD ,Q' P 'ELIZABETH A.NEVILLE,TOWN CLERK P.O.BOX 1179 iOConstruction
SOUTHOLD,NEW YORK 11971 a T
Alteration , /
Telephone ,0 Aro: $10.00 - Residential v
(516) 765-1801 -Nat .
'' $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 TU " /�o2000
APPLICANT NAME: JOHN L . ,I{oL 4cdo SA.
APPLICANT ADDRESS: P .0. L O/ /9 S
SouT/lDLot tib '`'7 // ? 7 / •
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/Vg ) O,1(, FAM i c y/ 2e-S/D EA/CL-'.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ,O/a) L . 11U/1-7A0O SA 1 L 7- AL-
OWNER
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OWNER MAILING ADDRESS: P. Oc 130,X /9 5
SOvTliot.O� IV Y, Iii 7/
OWNER PROPERTY ADDRESS: /6”5 NO/L77/ BAYV/acv 4.0AD
soul--/D Lb j A/( / /1 97/
TELEPHONE NUMBER OF CONTACT PERSON: 5841 -8,027 C'- 51i `5//.
TAX MAP NO. : Section 07 f e OD Block 63. 00 Lot 0.1!). 0o G Oo 7
CROSS STREET: 5 a e `...2 f7. 65/4-31 C/- REWOoc/ DA-it/6-'7--
BUILDING PERMIT NUMBER CROSS REFERENCE:
f
W\ I)nature o Applicant
RECEIVED BY : 1 °L!
/ Town Clerk's ffice
DATE: `L°` (6/00?
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
(2:__ ,..-::•:-E----.7 .:344 c,.tc.
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
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1,SIN E FAMILY RESIDE "W12 ONLY
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_ APPROVED
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-- EXCAVATION INSPECTION REQUIRED ]
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