HomeMy WebLinkAboutMartinez, David ,�Os �f FOL
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ELIZABETH A.NEVILLE `Z� may` ,
'� Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
N Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS P
MARRIAGE OFFICER %•%%t ° 1 Fax(516) 765-6145
RECORDS MANAGEMENT OFFICERmay*0 a0�111 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER 1 4( X11
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2055 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : DAVID C. MARTINEZ
Address 1 : P.O. BOX 1583
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 #R10-99-0035
Name Of Owner MARTINEZ, DAVID C. AND SUZANNE
Mailing Address 1 P.O. BOX 1583
City St Zip MATTITUCK NY 11952
Property Address 1 1700 ARBOR LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 121 .00 block 1 lot 1 .010
Cross Street BERGEN AVENUE
Building Permit Number Cross Reference:
Issue Date: 4/22/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
(PJ"%xlFFO(l(o,
ELIZABETH A. NEVILLE O l/,y Town Hall, 53095 Main Road
TOWN CLERK < „ P.O. Box 1179
Z ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS t v. rrt MARRIAGE OFFICER Fax (516) 765-1823
��
RECORDS MANAGEMENT OFFICER Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER _$9!
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 16, 1999
Transmitted herewith is a copy of application No. 2138 for a Cesspool/
Septic Tank Construction Permit submitted by:
David C. Martinez
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 applica ' n and location map of the project cited above
and make the following r ommendations:
APPROVE
DISAPPROVE
Comments:
ignatur
1Z-61a
Dated
r-
OFFICE OF THE TOWN CLERK s 's��1 ULk "
TOWN OF SOUTHOLD ��'' �OG Application No. a i 3
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 ; Alteration
Telephone !0) tzr $10.00 - Residential
(516) 765-1801 = ol * '' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION ''fry
A
for QPR 6 /999
CONSTRUCT ION or ALTERATION PERMIT rOwn r./
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE I
APPLICANT NAME: V fc Cr Ine z_
APPLICANT ADDRESS:^XX I5� T rkaatibiAc��
SEPTIC CESSPOOL f
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
c QQ
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTYPkar ,hC7. 13140CL.vtIt..Q Z T
x
OWNER MAILING ADDRESS:TpX 1:5<p&?
Oka-tit act_
OWNER PROPERTY ADDRESS: 1 7öO 1q r bo r l-.c
VVI )J2-1- ck
TELEPHONE NUMBER OF CONTACT PERSON: 903-0
TAX MAP NO. : Section IQ\_ Block \ Lot \ . \D
CROSS STREET: r `(.t L,C
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignat • of Applicant ai
\ I
RECEIVED BY: RICEItallv
Town Clerk's Office
DATE: NPR 16 1999
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