HomeMy WebLinkAboutConway, William ,II-,
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ELIZABETH A. NEVILLE I Gye N Town Hall,53095 Main Road
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TOWN CLERK % 1:2
P.O. Box 1179
y = Southold, New York 11971
REGISTRAR OF VITAL STATISTICS t
MARRIAGE OFFICER
*- 1 Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER =y 0`�,, Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER �" �'� 1, -0,�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2188 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : WILLIAM CONWAY
Address 1 : PO BOX 1902
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 #R10-99-0008
Name Of Owner CONWAY, WILLIAM & JENNIFER
Mailing Address 1 PO BOX 1902
City St Zip SOUTHOLD NY 11971
Property Address 1 YOUNG'S AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 55.00 block 2 lot 9.003
Cross Street OLD NORTH ROAD
Building Permit Number Cross Reference:
Issue Date: 11/17/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE i), Gy Town Hall, 53095 Main Road
TOWN CLERK N o ''� P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS "
MARRIAGE OFFICER Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER ��Ol ��0� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICERsiii
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 26, 1999
Transmitted herewith is a copy of application No. 2273 for a Cesspool/
Septic Tank Construction Permit submitted by:
William Conway
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 rec mmendations:
APPROVE
DISAPPROVE
Comments:
9Signatur
Ill 11_14l1
Dated
!.
OFFICE OF THE TOWN CLERK •'�' ' UL '
TOWN OF SOUTHOLD .' � �1 CQG= Application No. p2p9,7
ELIZABETH A.NEVILLE,TOWN CLERK �T
P.O.BOX 1179 :,t� Construction
SOUTHOLD,NEW YORK 11971
Alteration
Telephone ,� �Q �i' $10.00 - Residential CXR,
(516) 765-1801 =_01 •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 /0/02(-,1g
APPLICANT NAME: ()di I lam Ocl-mov
APPLICANT ADDRESS: T013 ,>, 1C0d,
SO Rff ICA ) y //97/
SEPTIC CESSPOOL t/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
1 / c4) s,nSL� � `ity Dc>er/,k�
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: L`I lgyp,,,,\d—j h h i4,.. Co n.,.0-t,x
OWNER MAILING ADDRESS: 'O IS'U(9,
'0GkYt 3/I A/Y )14 `7/
OWNER PROPERTY ADDRESS: Yo-i,..ris 4t/'L. .Sbkfe,.e/d
TELEPHONE NUMBER OF CONTACT PERSON: 7& �.51ac)--
TAX MAP NO. : Section b63- Block Cb? Lot oq,3
CROSS STREET: CO 'Matta'
BUILDING PERMIT NUMBER CROSS REFERENCE:
19'
ignature o pplica
RECEIVED BY :
Town Clerk's Office
DATE: /O/2 c./F9
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SUFFOLK CC' 1TY DEPARTMENT OF HEALTH SERVICES
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EXPi,-(... .,LIE YEARS FROM DATE OF APPROVAL
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1 15JAN99 REVISE WELL 8.SANITARY LOCATION