HomeMy WebLinkAboutSmith, John ��ir iii
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ELIZABETH A.NEVILLEh`Z� Gym Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS v. Ay
MARRIAGE OFFICER
Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER `. �fO �0�,•I� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER .' 0.
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2191 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN G SMITH
Address 1 : 465 TOWN HARBOR 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 #R10-99-0197
Name Of Owner JOHN G SMITH
Mailing Address 1 465 TOWN HARBOR LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 JACOBS LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 6 lot 4.006
Cross Street BAYVIEW AVENUE
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 ���h`1O am Town Hall,53095 Main Road
TOWN CLERK ' o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS t$ Southold, New York 11971
MARRIAGE OFFICER '� 1 Fax(516) 765-6145
%RECORDS MANAGEMENT OFFICER 4ijj a�� , 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: November 15, 1999
Transmitted herewith is a copy of application No. 2280 for a Cesspool/
Septic Tank Construction Permit submitted by:
John G. Smith
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 re mendations:
APPROVE
DISAPPROVE
Comments:
Signature
/ ( / Ila1gq
Dated
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OFFICE OF ME TOWN CLERIC �� ' ' UL - "
TOWNOFSOUTHOLD 0.
�Q = Application No.
ELIZABETH A.NEVI LE,TOWN CLERK
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 O
• In Alteration
Telephone y0� � �� $10.00 - Residential
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(516) 765-1801 '=y01 1 � ,�'� $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 // /
APPLICANT NAME: X11! (�- • carr L,
APPLICANT ADDRESS: /6$ f bW'�� ��� f 1) L LAAIE co-41 0(4,
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
MODULAR_ favi CAPE < ‘)1x
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: 4 S i° " k,e,it6)>z... LA,&1E
.c6vfl, a( ' Aiew yog t1ei7I
OWNER PROPERTY ADDRESS: Jig c_ota S L.A.)
71-in c .(‘
TELEPHONE NUMBER OF CONTACT PERSON: 7S s- 2c
TAX MAP NO. : Section - 9 Block to Lot 4
CROSS STREET: 13 y of ej At'
BUILDING PERMIT NUMBER CROSS REFERENCE:
1: A
Signature of Applicant
RECEIVED BY:
Town ler 's Office
DATE: �( ,
SURVEY OF LOT # 6 N
SUFFOLK COUNTY MAXIS/ENT OF HEALTH VICES W i___
MAP OF "GROWLEY ESTATES" EmowKIR APPROVAL OF CONSMOM1014 FORA
FILED DEG. 12, I186
, AS FILE # 8236 PAMfl Y o,�,i,Y
SITUATE: BAYV I E 4 HATS `/ 3�' O_ / 7 o r�7 S
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EI_.� ,.
TOWN OF SOUTHOLD ,(V _ APPROVED ' � t__
SUFFOLK GOUNTY, NY Q S6 FOR SOF DEDROOMs
SURVEYED 0I-12-99 �J I)') /°J MIRES ES n�'PS YEARS FROM DATE OF APPROVAL
AMENDED 09-05-99 �3 �1
SUFFOLK COUNTY TAX# CO ,,^^�• 1�// N
000 79 - 6 - 4.6 `VrIt V) 0ll
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CERTIFIED TO: \ r0/0 0/
JOHN G. SMITH /8, 0- v U
COMMONWEALTH LAND TITLE 3�, �M\�� EI=n �"
INSURANCE COMPANY 88 - , fb e
PEGONIG ABSTRACT, INC. J/
69, ori�(
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A STAKE FOUND 04 to E'=15
AREA = 96,147 SF OR 2.22 ACRES (/fir, tic)
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