HomeMy WebLinkAboutDemarest, Carl '•, " . FFOL f'•
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ELIZABETH A.NEVILLE ���_ G'y�; Town Hall, 53095 Main Road
TOWN CLERK % o P.O. Box 1179
ti
v, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Q � Fax(631) 765-6145
MARRIAGE OFFICER �f�i • �1
RECORDS MANAGEMENT OFFICER x449 .j ,i• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ..P���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2368 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CARL DEMAREST
Address 1 : 28280 MAIN ROAD
City St Zip ORIENT NY 11957
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 #R10-00-0084
Name Of Owner DEMAREST, CARL & DANIELLE
Mailing Address 1 PO BOX 305
City St Zip ORIENT NY 11957
Property Address 1 28280 MAIN ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 18.00 block 6 lot 23.001
Cross Street PLATT ROAD
Building Permit Number Cross Reference:
Issue Date: 7/18/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ��= '3 ; X Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
�y, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER y_'f1p1 #�6��� Telephone (631) 765-1800
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: July 17, 2000
Transmitted herewith is a copy of application No. 2356 for a Cesspool/
Septic Tank Construction Permit submitted by:
Carl & Danielle Demarest
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 reco endations:
APPROVE
DISAPPROVE
Comments:
Signature
'l ) , Y ( o a
Dated
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IS/II/I/./,,„,
OFFICE OF THE TOWN CLERK 's'h vFFUL ' !o
TOWN OFSOVIVOLD Application No. '`�
ELIZABETH A.NEVI LE,TOWN CLERK -
P.O.BOX 1179 , Construction
SOUTHOLD,NEW YORK 11971
Alteration
Telephone 0 �,' $10.00 - Residential
(631) 765-1800 -J 1ir 9;00 $25.00 -Non-Residential
• - '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE ETU q c9N CX)D
APPLICANT NAME: ar\ - 1 �I r �- mai
APPLICANT ADDRESS: ala-1,0 (Y111
r•i€.+ A- 1C151
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION r\ziz
&-Otrr
LOCATION. MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• OWNER OF PROPERTY: Cr1 + - -3). r—e ck -mctres+
OWNER MAILING ADDRESS: Q. O • Cjp)( 3D5
04 11957
OWNER PROPERTY ADDRESS: DaalD r1lastn `d•GA.
�r�e►�� , iVA ft51
TELEPHONE NUMBER OF CO T,,Q:CT PERSON:
TAX MAP NO. : Section Bloc Cot_
CROSS STREET: P,C�t Ric
BUILDING PERMIT NUMBER CROSS REFERENCE:
. "141” •
Signature o Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
.440
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