HomeMy WebLinkAboutLong, Dennis ,„iiia.
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ELIZABETH A. NEVILLE t _0 •
Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
v, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �Oy, �� � Fax (631) 765-6145
MARRIAGE OFFICER /�
RECORDS MANAGEMENT OFFICER Ql .aS,,' Telephone (631) 765-1800
j If FREEDOM OF INFORMATION OFFICER ��so
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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. 2243 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DENNIS & SUSAN LONG
Address 1 : PO BOX 924
City St Zip MILLERTON NY 12546
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 #R10-99-0206
Name Of Owner LONG, DENNIS & SUSAN
Mailing Address 1 PO BOX 924
City St Zip MILLERTON NY 12546
Property Address 1 GREENWAY EAST
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 2 lot 20.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 2/17/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE t°h`Z` t Town Hall, 53095 Main Road
TOWN CLERK ; p '� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v. �� Southold, New York 11971
MARRIAGE OFFICER : G 1� Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER -� *� -0 00 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER '� 4, '����
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 14, 2000
Transmitted herewith is a copy of application No. 2331 for a Cesspool/
Septic Tank Construction Permit submitted by:
Dennis and Susan Long
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 endations:
APPROVE
DISAPPROVE
Comments:
ignature
I "416O.
Dated
OFFICE OF THE TOWN CLERK ' \\MkK
TOWN OF SOUTHOLD ��� n CQ .0-73/--e41 Application No. 3/
ELIZABETH A.NEVILLE,TOWN CLERK O e
P.O.BOX 1179 Construction )
SOUTHOLD,NEW YORK 11971 Z
^' Alteration
t.
Telephone ,jj� �Q ��� $10.00 - Residentiafk' (D. DZ
(516) 765-1801 = 1 o' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ I b .OL
DATE l — Qp
APPLICANT NAME: -b 01, 60SA0 Lo,�
APPLICANT ADDRESS:
SEPTIC 1( CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
IJP LL) ►mac(, lL Fn vvt ( -we` t tC)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: b`1r,'ll) S ` . SAac.) �-o IUGj
OWNER MAILING ADDRESS: Au 0:30x q 2)4
OWNER PROPERTY ADDRESS: ((Vrff --)0c13a..f a�
efOT /
TELEPHONE NUMBER OF CONTACT PERSON: 5(55 - 3aq - '3T-03
TAX MAP NO. : Section �,1, � 00 Block 00 ,Q0 Lot 0 AO' OW
CROSS STREET: hk a,r}wJ R-CD
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
Iftertrita
RECEIVED BY:
Town EfegkIs40a8e
DATE:
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Y
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
DEPT OFFH:
PERMIT FOR APPROVAL OF CONSTRUCT/OW FOR a ,;-HYicr c
RIVER
H:ONLY t .,:j. 1
SEP 29 p3 59
APPROVED 4 �
POR MAXIMUM OF
EXPIRES TREE YEARS FROM DATE OF APPROVAL
I
Vin‘.,4,4)1 1 •[' •::;�A'/L
EXCAVATION INSPECTION REQUIRED
FOR SANITARY SYSTEM I
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PLEASE NOTE r% ' ../7,44,v.Jt/6L4
Minimum distance between well
and cesspool is to be 150 feet. y ✓ a �c 'ice'* / 5,4:,/
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