HomeMy WebLinkAboutEberhardt, J M •
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ELIZABETH A. NEVILLE 1 %
1= G'yd Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER RIAGE y'f101 �,OFFICER
Telephone(631) 765-1800
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FREEDOM OF INFORMATION OFFICER
S iii a/,I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2260 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EBERHARDT, J M
Address 1 : PO BOX 143
City St Zip EAST MARION NY 11939
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 #R10-00-0006
Name Of Owner EBERHARDT, J M
Mailing Address 1 PO BOX 143
City St Zip EAST MARION NY 11939
Property Address 1 GREENWAY WEST
City St Zip ORIENT NY 19570
Tax Map No. section 15.00 block 1 lot 20.000
Cross Street NORTH SEA DRIVE
Building Permit Number Cross Reference:
Issue Date: 3/01/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
of
ELIZABETH A. NEVILLE �� h� Gy7.4 Town Hall, 53095 Main Road
TOWN CLERK h P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O. i Southold, New York 11971
MARRIAGE OFFICER :�4,, ��,�1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER '/Q *Doti Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 25, 2000
Transmitted herewith is a copy of application No. 2346 for a Cesspool/
Septic Tank Construction Permit submitted by:
J. M. Eberhardt •
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.
(6(--1(--Ce
GCS
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
gnature
t
Dated
r , 1
OFFICE fi 'THE TOWN CLERK ''"OULU*.
',TOWNOFSOUTHOLD ,,'' : Application No. OS q i
Fi.17ABE17I A.NEYIL E,TOWN CLERK � /
P.O.BOX 1179 ? ' „ ; Construction
v
SOUTHOLD,NEW YORK 11971 `
W Alteration
Telephone s; �.`. $10.00 - Residential `'�
(516) 765-1801 1
��' $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 2 - f= oa
APPLICANT NAME: Z Z.-/.�t�y92e 7
APPLICANT ADDRESS: X2 v 0o/1.,- / 5'3
e_----4.f7 /i 4 o'✓ v //f-f7
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
BCJcr�J /1o4Jle"--
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ✓- /17, L e/ X'44a7
OWNER MAILING ADDRESS: / ° oma4- /Y•-7
e-)9_1 7 .A-7 r94 4411 Z% //f-11j
OWNER PROPERTY ADDRESS: 6'7/Z ecriJc, t./c-7.-f•7
TELEPHONE NUMBER OF CONTACT PERSON: 2 'r (Y2‘.
TAX MAP NO. : Section 411111111 -Block d/ Lot -Z 0
CROSS STREET: ,7-1‘)17-( .11-'9 0.04, 2. c.---
BUILDING
0?., 2c�BUILDING PERMIT NUMBER CROSS REFERENCE:
l/- %
- Signature of Applicant
RECEIVED BY: c- 111/6144-1—
Ton Clerk's Office
DATE: ,,P-- T io
The locations of wells and cesspools
show? hereon are from field observations
f and or from data obtained from others.
• SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
, ORI SINGLE FAMILY RESIDENCE ONLY
9EA DATE a\-a\ HS REF.iiok e40- D0-000&
N&II° APPRbVED w
FOR MAXIMUM OF BEDROOMS. .
EXPIRES THREE YEARS FROM DATE OF APPROVAL
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