HomeMy WebLinkAboutVan Duzer, Charles /0stfFO�,�40
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ELIZABETH A. NEVILLE • Town Hall, 53095 Main Road
TOWN CLERK ` P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
� Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER - "'/01 it* eto Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,to
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2362 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CHARLES VANDUZER
Address 1 : PO BOX 205
City St Zip PECONIC NY 11958
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 #
Name Of Owner VANDUZER, CHARLES
Mailing Address 1 PO BOX 205
City St Zip PECONIC NY 11958
Property Address 1 ARROWHEAD LANE
City St Zip PECONIC NY 11958
Tax Map No. section 98.00 block 2 lot 17.000
Cross Street INDIAN NECK LANE
Building Permit Number Cross Reference:
Issue Date: 7/12/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE • Town Hall, 53095 Main Road
TOWN CLERK H - % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS V+' Southold, New York 11971
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MARRIAGE OFFICER Fax (631) 765-6145
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RECORDS MANAGEMENT OFFICER =__"'/Q! Telephone,l• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER .9"
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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: July 7, 2000
Transmitted herewith is a copy of application No. 2450 for a Cesspool/Septic Tank Construction
Permit submitted by:
Charles VanDuzer
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: 1t r e Q_1 a •
Signature
-1( , o / o0
Dated
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OFFICE OF THE TOWN CLERK V
41.1���FO�//� ED
TOWN OFSOUCHOLD ' �1 Q Application No.
3(4 W''
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 , Construction
SOUTHOLD,NEW YORK 11971 4.Z
Vca:i71T ; Alteration
Telephone , . Q . $10.00 - Residential ��
(516) 765-1801 -_' 1 440
,'' $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 6-/906
APPLICANT NAME: (1/,'j M) 2e
APPLICANT ADDRESS: &)C c905- Pet%'Gut'c 1 /9s8
SEPTIC `V CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Vri-Ct) 1 -C.—
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTgey . I N AL �EjR lION:
OWNER OF PROPERTY: C .J %�'(J �LT
OWNER MAILING ADDRESS: MI6( 75 nef.Jr< 7/f,
OWNER PROPERTY ADDRESS: /9/?/t'v44 ,41 (,1,v.' /416,0vC 7 //551
TELEPHONE NUMBER OF CONTACT PERSON: '-23C, - 735----
TAX
35'TAX MAP NO. : Section 9 t Block CZ_ Lot / 7 .¢ / $'
CROSS STREET: • `,UA4,k) ikJcC`( t
BUILDING PERMIT NUMBER CROSS REFERENCE:
i
Signatures' ppl� •nt
RECEIVED BY.
I own Clerk's Office
DATE:
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