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HomeMy WebLinkAboutConnell, Mike •o, Oq FFOu. ELIZABETH A.NEVILLE '01& co Town Hall, 53095 Main Road TOWN CLERK '� P.O. Box 1179 = Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ;O4v7/1 Fax(516) 765-6145 MARRIAGE OFFICER ` JJ OTelephone (516) 765-1800 RECORDS MANAGEMENT OFFICER � 1 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. 2163 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : MIKE CONNELL Address 1 : 715 LIBERTY LANE City St Zip SOUTHOLD NY 11971 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 #R10-99-0181 Name Of Owner MIKE CONNELL Mailing Address 1 715 LIBERTY LANE City St Zip SOUTHOLD NY 11971 Property Address 1 425 LIBERTY LANE City St Zip SOUTHOLD NY 11971 Tax Map No. section 79.00 block 6 lot 8.000 Cross Street VICTORIA DRIVE Building Permit Number Cross Reference: Issue Date: 10/05/99 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) • le0,••ilii��.. �i C'°. 3 fele ELIZABETH A.NEVILLE �I S Gym • Town Hall, 53095 Main Road TOWN CLERK H% .: , P.O. Box 1179 REGISTRAR OF VITAL STATISTICS ; ,t� Southold, New York 11971 MARRIAGE OFFICER . `F 1 Fax(516) 765-6145 RECORDS MANAGEMENT OFFICER �-.. 0 a��'1�� Telephone(516) 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: September 23, 1999 Transmitted herewith is a copy of application No. 2249 for a Cesspool/ Septic Tank Construction Permit submitted by: Mike Connell . 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 recommendations: APPROVE ✓/ DISAPPROVE Comments: Signa e Dated OFFICE OF THE TOWN CLERK ��` TOWN OF SOUTHOLD ,�' CDlj �, Application No.22i ELIZABETH A.NEVUJ.F,TOWN CLERK ; ft cf. • Construction P.0.BOX 1179 SOUTHOLD,NEWYORK11971 : Cee m ; Alteration $10.00 - Residential Telephone (516) 765-1801 -. 'L + ." $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 9 - Z - 91q APPLICANT NAME: ñ1iE APPLICANT ADDRESS: I I i LI her-tuk Lct . e. nr-1.t-t-hr lcl (,010( k 11cr"I I SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /�� Po1JoS E57) ,i.57lz,t)C�l�1�1�J 151UE t ls1 rcucc LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION/ OR ALTERATION: OWNER OF PROPERTY: M i K e Colo hU OWNER MAILING ADDRESS: -1I `j L.1he(11LUPC jC �1 1 "1I I 11 OWNER PROPERTY ADDRESS: 14 25 LI bct'J I-CA nc' (.)/it( h© Ick )19 �1 I TELEPHONE NUMBER OF CONTACT PERSON: SOAR-0U V 6e-18)0/46&10i 173-67/4 TAX MAP NO. : Section l Block Lot c� CROSS STREET: 3 ,I, 66 jZiz.I1 le - BUILDING PERMIT NUMBER CROSS REFERENCE: 717. 0t...Q Signature of Applicant RECEIVED BY: SAMARA gTEpNpIWSp To n k s Office Nary I 4IIA! DATE: ? imieremelionlipt.csaw r 1 -r- 5T IA OLE GRADE 2' BROwN 51LTYTAt SHARON O'BRIEN }' 00 O M 11 3' F3R4,hils1 cogN►y SAND 54 Middle Island Road b 3 p ›-, c� PALE BRov'N FINE Mt. Sinai. N.Y. 11766 ° °� ►..a W VI (V 13' ; -TO M E O. 5AN 0 W >,� Z �p ,� i' ; 1312.0w/4 stclry SAND c173 -07�� 3 o �," .� sx ''" o°.NI o ' i PALE =aoWN i i.1a p�v� �„+ U O\ 23 o �. • ° = ° 0 t/1 H �.t•G A rlT `" ° pq N ;04 -4) O .z ho ,� p U ON N ' \ fs, o—1-- g) -c cueo c � � cnL cl trU 0 0 v) ff.)) ›-, Q ai pp [--,- iern) i--i cel 1 is�1. S � . alb z ii Z (4 Q ,1 0 o K1i�2t 3.�. 8 W O RS 0 = v.-1 ig 5 d cit,-, a, -1. .NFAN. FL- 93.53 o W h5 \ ww r" C► ��CvP.R,F(.- g2.0 a rn o tx GQ ...v� to o _ P 20 P. Ito. 4 ° - : Q N Res• p i v figL_________�-+ •W Q -� . e-•� U' A w kll ^ \ N ( �r__ 5O ;2 ..` 43 c� '-1 50 `9 0^_ It EXCAVATION IN4SPEC ION REO1 q.v.-' • '� i 3 fi v 54 " 0 1�i FOR SANITARY SYSTEM'! :h i - e.: 1p oY HEALTH DEPARTMENT ::„0.:.. ''t1 -$- c cd _ 4 ,N Q a 2 d in di i rax UXJN'!Y DBTARTIO�'T OF HEALTH SERVICES Do L N. r J AI �"® PERM?FOR a.c 1 .%1 \sc/�, LL a FAMILY R ONLY l A .a . 96.4 $7. TE f 3_'-L�1 . REP. e / 0 - `Ai. _I� IBJ "'7' .41. 1 O' 1"J E P' 1 �_ •C=1=7 1 :10b I s-APPROVED ' w $.70 - o E '34,'34,9` I t 0FOR MAXIMUM OF 401 44.4 3 y �NO `O EXPIRES mum YEA=PROM DATE OF APPROVAL E cv 1..... 1 �� -• 'T�/ .o ( . --e:.-e• w� - 6 a) -Q ��� N"T" y o e /.E S. N Z e4 \ - > ES �W