HomeMy WebLinkAboutEdson, Grace (2) \IFF001-
ELIZABETH A. NEVILLEcotTown Hall, 53095 Main Road
TOWN CLERK <?�� P.O. Box 1179
ti Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 11.7 Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICERy� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ?� 10 * f�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2212 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MARY KIRSCH
Address 1 : PO BOX 668
City St Zip MATTITUCK NY 11952
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 #R10-99-0198
Name Of Owner EDSON, GRACE
Mailing Address 1 PO BOX 1526
City St Zip SOUTHOLD NY 11971
Property Address 1 9720 MAIN BAYV I EW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 87.00 block 5 lot 24.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 12/28/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
Pro-
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. „, '0004
ELIZABETH A.NEVILLE 4��'Z� 0Gy�, Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER '1C 1� Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER 4s, / Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER = '� 41 so
I I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 16, 1999
Transmitted herewith is a copy of application No. 2300 for a Cesspool/
Septic Tank Construction Permit submitted by:
Mary Kirsch •
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:
V
S gnat T;
Dated
•
' OFFICE OF THE TOWN CLERK ''',�' �`1 otKC'-
TOWN OF SOUTHOLD
Application No.@5C,O
ELIZABETH A.NEVILLE,TOWN CLERK Ql/
P.O.BOX 1179 !r` Construction
SOUTHOLD,NEW YORK 11971
^' Alteration
Telephone ,y / $10.00 - Residential
(516) 765-1801 l o' $25.00$25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION REM,11ein
for DEC 1 6 1999
CONSTRUCTION or ALTERATION PERMIT town Cleric Southold
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE '4< //6,/7�
APPLICANT NAME: 44,y c 1-7/ Cr"0 A)7/P4cT- V&AVEE-
APPLICANT ADDRESS: ( 4
/1,1 T/ 7 ���� l J. y / PS
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
1 f79 i, ? y ,01,t1I
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY: S
OWNER MAILING ADDRESS: 61. O- /64') >c- /5 0) C,
GL / 1 j / '? 21
OWNER PROPERTY ADDRESS: 9'7 2 0 7124, 4 y Iu] e4•
S o j Ti!oL() 1 x1. y // ? 7/
TELEPHONE NUMBER OF CONTACT PERSON: /VA/Q /
TAX MAP NO. : Section cS 7 Block 0_6— Lot Q
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sig ture o Applicant
RECEIVED BY:
Clerk's Office
DATE: \e - `(/2l cti)
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TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
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' COUNTY DEPARTMENT OF HEALTH SERVICES
' PIRMIT FOR APPROVAL OF CONSTRUCTION FOR AACCORDANCE W.THE 4.10.1.151.1 -
/ .., i,ADARDS FOR mu SURVEYS AS ESTABLISH. .
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ei?4,4,÷4 J''''•. EXCAVATIIIII IPISPECTIOPI InnJoseph A. Ingegno
,ON t.JF'HIS SuRRE,NAP RuT of...., I
•nr. .440•91135ErCri'5 AKE°3. , Land Surveyor
EmBOREG SEAL SHAR.NOT NE,ONSTEP, ,
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,FR,,TION5 INO.CArEP•IEFrioN 511.5,„-,51A T
A.•'5 THE PERSON 100 550005 000,0,
s RRLRARED AND,HIS BEN,7.',N -,IN,Sun.'s -Suba,v.ons - Sae Ma, - Construtt,on Layout
IOU 0.1PANY GOVERNMENTAL AGEN.RN.
ANEW,0•15t1YVTION,ISTEC HEREON.ANS
'3".4 ASSIGNEES 0,THE LENCANG INST. PHONE(516)727-2090 fax .516)722-5093 , f-
.,-c N CERTIF,CANWIS APE NO,TRANSFERABLE
000.CE5 00970000 005195 ADDRESS ,
THE ExISTERCE OF RIGHTS OF WAY
AND/OR EASEMENTS OF RECORD.if One Un.on Square P 0 Box 1931
ANY,NOT SHOWN ARE NOT GUARANTEED Aaueporgve.New TPO 1931 R,ornood.Now YOrir 1/901 .
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