HomeMy WebLinkAboutPalmer, Robert 0, OfF0(,tc
ELIZABETH A. NEVILLE � Town Hall, 53095 Main Road
TOWN CLERK o '� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v Southold, New York 11971
MARRIAGE OFFICER :�,ti �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER Q 4: 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. 2385 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JEFF BUTLER
Address 1 : PO BOX 634
City St Zip SHOREHAM NY 11786
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 #R10-00-0154
Name Of Owner PALMER, ROBERT
Mailing Address 1 666 OLD COUNTRY ROAD
City St Zip GARDEN CITY NY 11530
Property Address 1 9204 BRIDGE LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 73.00 block 2 lot 3.006
Cross Street OREGON ROAD
Building Permit Number Cross Reference:
Issue Date: 8/15/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �_ co
01 Town Hall, 53095 Main Road
TOWN CLERK ; y - P.O. Box 1179
ZSouthold, New York 11971
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REGISTRAR OF VITSTATISTICS ` Fax (631) 765-6145
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MARRIAGE OFFICER `. y01 NO,"RECORDS MANAGEMENT OFFICER ,i 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:
Transmitted herewith is a copy of application No. 2474 for a Cesspool/Septic Tank Construction
Permit submitted by:
Jeff Butler as agent for Robert Palmer
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:
S' ature
q
Dated
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OFFI E OF THE TOWN CLERK ���� �l{ 0�1�
TOWN OF SOUTHOLD o''O� e6\ Application No. 2/1-i74'
ELIZABETH A.NEVI!I F,TOWN CLERK O 7Construction
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P.O.BOX 1179 ; !�
SOUTHOLD,NEW YORK 11971 : Z
Alteration
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Telephone
4490
,� Qore't $10.00 - Residential 1$
(516) 765-1801 ' �.� ��
,��' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE ?-
APPLICANT NAME: ,CoPf sc- 1742-)426"-) /76-74" G �T ,� i 46W7-
APPLICANT ADDRESS: PO, 4,e 6S V
S ae %x/M, /1/. �! /17gz-
SEPTIC XSSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
S',Na l.E oeE=ti /!i&Z'
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /2o447 A/1762
OWNER MAILING ADDRESS: ,4(4.- OLD C . V � £
62 ,7 /y •
OWNER PROPERTY ADDRESS: TF0.16 ci/ /5 /4Q66' 44,5
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TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section G 7 3 Block o Lot 3.
CROSS STREET: -gr-7-Pb--e--Z719-A4. GzJ �
BUILDING PERMIT NUMBER CROSS REFERENCE:
I ,
- of Applicant
RECEIVED BY :
Town Clerk's Office
DATE: ?//0/e0
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SURVEY OF LOT #2
Np S��Nfl FOR RoMBI N A.SUBDR 1 URN
\-014-,,\5 3i ,�156'16 •
., MARY ELIZRBETH MURPHY
iii4 .� 1 SITUATE. GUTGH06LE
48 TOYW OF SOUTiiOLD'
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SURVEYED 1
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01-01-00I
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1000 NOTES:
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