HomeMy WebLinkAboutHeins, Janet �,,
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ELIZABETH A. NEVILLE s eyam►; Town Hall, 53095 Main Road
TOWN CLERK o +c P.O. Box 1179
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Southold, New York 11971
REGISTRAR OF VITAL STATISTICS k‘%?/
0 Fax (516) 765-6145
MARRIAGE OFFICER `
RECORDS MANAGEMENT OFFICER '
�O ,1� Telephone (516) 765-1800
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FREEDOM OF INFORMATION OFFICER 1 411aO'�/
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2179 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JANET E. HEINS
Address 1 : 575 ROBINSON LANE
City St Zip PECONIC NY 11958
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 #R10-00-0204
Name Of Owner HEINS, JANET E.
Mailing Address 1 575 ROBINSON LANE
City St Zip PECONIC NY 11958
Property Address 1 ROUTE 25
City St Zip SOUTHOLD NY 11971
Tax Map No. section 75.00 block 3 lot 1 .000
Cross Street SOUTH HARBOR ROAD
Building Permit Number Cross Reference:
Issue Date: 10/25/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
. , 02-i -
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ELIZABETH A.NEVILLE /,•=�0 t Town Hall, 53095 Main Road
TOWN CLERK % o - % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v. �� Southold, New York 11971
MARRIAGE OFFICER
O tFax(516) 765-6145
RECORDS MANAGEMENT OFFICER �- f,49iig a0-or Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ‘.-1-•,,. # „,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: October 22, 1999
Transmitted herewith is a copy of application No. 2264 for a Cesspool/
Septic Tank Construction Permit submitted by:
Janet Heins •
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 mendations:
APPROVE
DISAPPROVE
Comments:
ignatu
Dated
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OFFICE OF THE TOWN CLERK ,'e• �t.1 OL� ,�"
TOWN OF SOUTHOLD 144,% Cwe,-- Application No. 2-2-4//
ELIZABETH A.NEVILLE,TOWN CLERK /
P.O.BOX 1179 ; _ Z Construction 1k_SOUTHOLD,NEW YORK 11971 ; G T
Alteration
Tele hone Off' zri • $10.00 - Residential ( 4...______p
(516) 765-18010l ,�'� $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 /a 1C- 17
APPLICANT NAME: 2 '113
APPLICANT ADDRESS: g-7 c (04cs.,) Com_
2-9A ,( 1 a sr,
SEPTIC /CESSPOOL '. -
DESCRIPTION
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: CC „'z_
OWNER MAILING ADDRESS: ,54. /Ii(
OWNER PROPERTY ADDRESS: a 2
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TELEPHONE NUMBER OF CONTACT PERSON: 73 -- (-03/q
TAX MAP NO. : Section Block Lot 0 I
CROSS STREET: 6 ri o—ti c5
,_..„c_____________
BUILDING PERMIT NUMBER CROSS REFERENCE:
)04 e -(4,_, „
Signature of Applicant
RECEIVED BY: ___V--)
own Cle Tce
DATE: / D (J
4- PM APPROVAL OF CO1tS'IRUC'ITON FOR A •
SINGLE FAMILY RESID• CE ONLY
./ATE l6=7 -941 HS : . $ 0 ..9 ,0„). o
W APPROVED Aka .LSI IFY/.. 4./
FOR MAXIMUM OF 4 . , ..,A,
6XP1RES THREE YEARS FROM D TE OF0
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