HomeMy WebLinkAboutLawther, Elizabeth �StFFOO,.'=
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ELIZABETH A.NEVILLE 1�� OG* ; Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ‘`.14,&
v' � Southold, New York 11971
MARRIAGE OFFICER : �iL ���,' Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER '/Q! a0ii Fax
(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. 2371 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN F LARSEN
Address 1 : 9 HIGHLAND AVENUE
City St Zip ST JAMES NY 11780
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 #R10-99-239
Name Of Owner ELIZABETH O. LAWTHER
Mailing Address 1 142 FREEMAN AVENUE
City St Zip ISLIP NY 11751
Property Address 1 175 LAKE DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 5 lot 23.000
Cross Street KENNY'S ROAD
Building Permit Number Cross Reference:
Issue Date: 7/18/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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(23-7 (
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ELIZABETH A.NEVILLEy1 Town Hall, 53095 Main Road
TOWN CLERK H - P.O. Box 1179
v, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS p yC ?
MARRIAGE OFFICER Fax(631) 765-6145
,L
RECORDS MANAGEMENT OFFICER
‘-7491 if/ , Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 0
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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 18, 2000
Transmitted herewith is a copy of application No. 2459 for a Cesspool/
Septic Tank Construction Permit submitted by:
John F. Larsen for Elizabeth O. Lawther
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 recom endations:
APPROVE
DISAPPROVE
Comments:
Signature
t of f o
Dated
lore . -
OFFICE OF THE TOWN CLERK ,,''��VUL�1' '
TOWN OF SOUTHOLD 11�'O f.QG Application No.2
J79j
F ABETH A.NEVILLE,TOWN CLERK O
P.O.BOX 1179 Construction__,,
SOUTHOLD,NEW YORK 11971 ` o T
Alteration
Telephone ‘0� 0- $10.00 - Residential
(631) 765-1800 �= 1 i 0,0" $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee .$
DATE 7- ( -
APPLICANT NAME: Jb HAD F , L,p R EAS
APPLICANT ADDRESS: l )4 / V-) 7‘..)6D U F -
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
&v- !Vs2-1w 5/ A) (r-L Fv=k ) �,y -S 7 o EAT, z- I C
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: fL 1 ZAISE-rk4 O, LL,374
OWNER MAILING ADDRESS: t , A.K) PV E
OWNER PROPERTY ADDRESS: t15- (�44e. L>jZ ,
-t.)-7-)4o ,
TELEPHONE NUMBER OF CONTACT PERSON: G3 / ? Z—
TAX MAP NO. : Section Block Lot_ 2.3
CROSS STREET: ��tiAS JZ6)
BUILDING PERMIT NUMBER CROSS REFERENCE:
I •
, r Q �
•ignature of Applicant
RECEIVED BY:
=� n 's Office
DATE: A M.
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SURVEY OF PROPERTY
:a 7'FOLK COUNTY DEPARTMENTOF HEALTH SERVICES
SOUTHOLDSITUATED AT
i ..RAIITFOR APPROVAL O1 CONNSSTRUCTIONFOR A TOWN OF SOUTHOLD
eINGLEFANIILYIR&SIDENCLONLY ; I SUFFOLK COUNTY, NEW YORK
to -of`> _3QEPL 0 S f.:TAX No. 1000-59-05-23
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'S�d SCALE 1 =40'
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+ ,i-. EXPIRES THREE YEARS FROM DATE OF APPROVAL
�4' •• a 41 wErL � AREA = 22,992.82.58acsq. ft.
o.sza Da.
-al' Tea—E O `Approved in accordance with rd of Revises
AdA � '1,6 Ip CERTIFIED TO:
' `' determination dat UO
s JOHN LARSEN
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TWEM.CERT,R0ma16 AE RIOT IWAOR1MDL PRONE(S16)727-2090 Fox(518)722-5093
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