HomeMy WebLinkAboutKiefer, Joan 4
•
ELIZABETH A.NEVILLE .Z �l/.y Town Hall, 53095 Main Road
TOWN CLERK .• ` P.O. Box 1179
N Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER N.4# 0� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER 49/-
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2218 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOAN KIEFER
Address 1 : 54-34 64TH STREET
City St Zip MASPETH NY 11378
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 #R10-99-0103
Name Of Owner KIEFER, JOAN
Mailing Address 1 54-34 64TH STREET
City St Zip MASPETH NY 11378
Property Address 1 115 TERRY LANE
City St Zip ORIENT NY 11957
Tax Map No. section 14.00 block 3 lot 3.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 12/28/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
to�,,,�SStFFota:1; V%‘4:
ELIZABETH A.NEVILLE ,,t�0 Ot; Town Hall, 53095 Main Road
TOWN CLERK % o - % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS t I/c4 t
� Southold, New York 11971
MARRIAGEV
Fax(516) 765-6145
OFFICER
RECORDS MANAGEMENT OFFICER y'*O �0�/iI Telephone (516) 765-1800
1
FREEDOM OF INFORMATION OFFICER .'�/ �18%Biel _
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 21 , 1999
Transmitted herewith is a copy of application No. 2306 for a Cesspool/
Septic Tank Construction Permit submitted by:
Joan D. Kiefer •
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.
4- 1'-'64—
Linda
wLinda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
2atu '
r
ee
/ 9.- ) 1 / q9
Dated
OFFICE OF THE TOWN CLERK ,1', UL/
TOWN OF SOUTHOLD I
� � CQG Application No. a3ci
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 tO !� Construction !/
6c z
SOUTHOLD,NEW YORK 11971
Alteration
Telephone Or �Qr, $10.00 - Residential E.
(516) 765-1801 �l �,��'� $25.00 -Non-Residential
-4,0''
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: J 0 .4-Ni D ft ; to 1= ? 1Z
APPLICANT ADDRESS: ,51/- ?3L/ ‘ V S r
/ 1g4-?erht ,t). y 113 7'5'SEPTIC /CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/11.2 c cJ // '11Q -
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: -te-Alit t ie, 'J={ ,
OWNER MAILING ADDRESS: _....*; :e"- 7 111 . S,IPVL ,4S Mem
OWNER PROPERTY ADDRESS: ////$T je1-A/212 y
0-A-4-L-1"
TELEPHONE NUMBER OF CONTACT PERSON: '7/ -- g'9 �-J -42
TAX MAP NO. : Section ' /tf Block 3 Lot ".-
CROSS STREET: ' j.ctA /Q./ 1)
.4
BUILDING PERMIT NUMBER CROSS REFERENCE:
f
. 0
,..„J
Signature of Appli, nt
RECEIVED BY :
Town Clerk's Office
DATE:
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6 EAST MAX4 STREET N.Y.-8.12C NO.50202
RPI-1I0 SCALE;r= trO' RIVERHEAD,N.Y.11901
NB 369-8288NX 369-8287 WA D1V010011/1817-f
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