HomeMy WebLinkAboutSmith, Steven ELIZABETH A. NEVILLE e� 4. Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS v�
MARRIAGE OFFICER O `� 1� Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER ��y?j61aO�/11� Telephone (516) 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. 2140 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : STEVEN J. SMITH
Address 1 : 12 EMERALD LANE
City St Zip HUNTINGTON STATION NY 11746
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 #R10-99-0137
Name Of Owner SMITH, STEVEN & DONNA
Mailing Address 1 (CONTRACT VENDEE)
12 EMERALD LANE
City St Zip HUNTINGTON STATION NY 11746
Property Address 1 TOPSAIL LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 7 lot 13.000
Cross Street NORTH BAYVIEW ROAD
Building Permit Number Cross Reference:
araktdatzza Z
Issue Date: 8/25/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. LE 2 3 l99� Gy•A• Town Hall, 53095 Main Road
TOWN CLE - ' P.O. Box 1179
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REGISTRAR OF VITAL STAT - 7 c r T �, Southold, New York 11971
MARRIAGE OFFICER ", ` Fax�� Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER vl *.pl61� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
•••„ i0°'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 23, 1999
Transmitted herewith is a copy of application No. 2226 for a Cesspool/
Septic Tank Construction Permit submitted by:
Steven J. Smith (contract vendee)
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.
t75.4-1(-e14.-
Linda
7wLinda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recom endations:
APPROVE
DISAPPROVE
Comments:
�gnature
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Dated
OFFICE OF THE TOWN CLERK e'l'C' four
TOWN OF SOUTHOLD %`''� CSG Application No.v� o?L
ELIZABETH A.NEVILLE,TOWN CLERK 4 '-i
P.O.BOX 1179 : '� ;L ; Construction
SOUTHOLD,NEW YORK 11971 t==3 Alteration
Telephone ‘,...V4.. i>
(516)
$10.00 - Residential
(516) 765-1801 -- l 41 ►''., $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE Y//0 /
APPLICANT NAME: \YT E(/Z,t/ 1 $M/ i7c
APPLICANT ADDRESS: /c) E/IIE,I4L/) L,Q.Ue,
I/Q irriA Tart/ sr7A 776uj /V J. 1/7 y
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: JT(U ✓ ,j• Do,UNA S,s?ITf/ Co., 7(.4Cf frAvees)
OWNER MAILING ADDRESS: /- E/liti< t z,q,v/
1--(G.v/u/c U,✓ cc fs.4 T/c.).uC RN.Y 4/77 4/6,
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OWNER PROPERTY ADDRESS: /(:)QcD- 7th-- f-J %Of°J,¢,v/LE� L,4,JE
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765- 5t/,"�W) 194 G-t2 #
TELEPHONE NUMBER OF CONTACT PERSON: j JC�i� Y•8,e7lty- 77'/-d79p
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TAX MAP NO. : Section - .) Block 70 Lot / _3
CROSS STREET: NO/z I 8/9A-(0 ,eO4D
BUILDING PERMIT NUMBER CROSS REFERENCE:
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/ Signature of Appli nt
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RECEIVED BY e' ; , p —
Town Clerk's Office
DATE:
v4,447 & SURVEY OF
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q YAP OF
? °j tu,,G w #MI LEEWARD ACRES AT BAYVIEN
NORT FRE w.. 5599 num)SITUATBD JUNE
1971
- e:; \ ' _ N B BAYVIEW
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PA.
I TOWN OF SOUTHOLD
O f'`mow. :, ROAD W q� SUFFOLK COUNTY, NEW YORK
N - S.C. TAX No. 1000-79-07-13
SCALE 1'=40.
O ° .e _ JUNE 9, 1999
AUGUST 4. 1999 MDED ADDITIONAL SURROUNDING WELLS A CESSR
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