HomeMy WebLinkAboutSchwed, Roger �o'O)3FFo(,
• IELIZABETH A. NEVILLE = *•
Town Hall, 53095 Main.Road•
TOWN CLERK ` y • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS f1 i Southold, New York 11971
MARRIAGE OFFICER :ii Ql � e Fax (631) 765 6145
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RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2351 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : EUGENE JACOBSEN
Address 1 : 51 LINDA LANE WEST
City St Zip RIVERHEAD NY 11901
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW TO EXISTING SYSTEM.
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner SCWED, ROGER
Mailing Address 1 225 WEST 106TH STREET, APT 11A
City St Zip NEW YORK NY 10025
Property Address 1 1735 PARK AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 2 lot 33.000
Cross Street MARRATOOKA ROAD
Building Permit Number Cross Reference:
Issue Date: 6/26/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE to if S; Town Hall, 53095 Main Road
TOWN CLERK %% o P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
00 1
ts
MARRIAGE OFFICER . 4, Fax 0 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER "'/Q1 �a�0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,.so
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 22, 2000
Transmitted herewith is a copy of application No. 2439 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Eugene Jacobsen
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:
.X.
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings, property..,....„....,,...,..._,_,........,_
__..._lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
Signature
G 1 -1--1---/ e 0
Dated
/ \�OLK
OFFICE OF THE TOWN CLERK '11��
TOWN OFSOUTHOLD � CQG= Application
ELIZABETH A.NEVU.i.F,TOWN CLERK � oV
P.O.BOX 1179 Construction iNeo
SOUTHOLD,NEW YORK 11971
C=I rrt Alteration ✓
O 103--00 Residential J
Telephone
(516) 765-1801 _ l ,�' $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 (%'/;1/0°
APPLICANT NAME: Eugene Jacobsen
APPLICANT ADDRESS: 51 Linda Ln. W. Riverhead, NY 11901
SEPTIC O CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Construct new outside shower with seperate dryweli.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
Roger Schwed
OWNER OF PROPERTY:
225 W. 106th Street Apt. 11a
OWNER MAILING ADDRESS:
New York, NY 10025
OWNER PROPERTY ADDRESS: 1735 Park Avenue
Mattituck, NY 11952
TELEPHONE NUMBER OF CONTACT PERSON: 631 -208-0898 (Gene)
TAX MAP NO. : Section 123 Block 2 Lot 33
CROSS STREET: Marratooka Rd.
BUILDING PERMIT NUMBER CROSS REFERENCE:
-.011111111111111111111111.1
�/' ig ature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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