HomeMy WebLinkAboutRachlin, Stuart �OFF04eO
G Town Hall, 53095 Main Road
ELIZABETH A. NEVILLE �may` y� �
TOWN CLERK t o
.c P.O. Box 1179
y Z tSouthold, New York 11971
REGISTRAR OF VITAL STATISTICS v. v'
MARRIAGE OFFICER
p Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER `AO a, ,I Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER •' '��i��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2061 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DIAMOND BUILDERS, INC
Address 1 : PO BOX 2100
City St Zip GREENPORT NY 11944
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 #R10-99-0007
Name Of Owner RACHLIN, STUART & KAREN
Mailing Address 1 26 WENWOOD ROAD
City St Zip HAUPPAUGE NY 11788
Property Address 1 EAGLE NEST COURT
City St Zip LAUREL NY 11948
Tax Map No. section 127.00 block 9 lot 8.000
Cross Street WHITE EAGLE DRIVE
Building Permit Number Cross Reference:
Issue Date: 5/05/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
••%'
Tow/re,>, n
ELIZABETH A.NEVILLE % yO l/y Town Hall, 53095 Main Road
TOWN CLERK � �c � P.O. Box 1179
N Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER 45 O� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER �0/
i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 3, 1999
Transmitted herewith is a copy of application No. 2147 for a Cesspool/
Septic Tank Construction Permit submitted by:
Diamond Builders for Stuart & Karen Rachlin
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 c/
DISAPPROVE
Comments:
gnature
Dated
t-- I r
OFFICE OF THE TOWN CLERK 14, `` f CIL v
TOWN OF SOUWHOLD �1` �I
�' Q� C�l/'� Application No. / `f?
ELIZABL'11(A.NEVIL1.E,TOWN CLERK ►�, .
P.O.BOX 1179 !� Construction �✓
SOUTHOLD,NEW YORK 11971 o r=T+ ;
Alteration
Telephone 0,j%,0 tQ..i $10.00 - Residential ✓
(516) 765-1801 _ 1 li �jot's $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 filifl 3 , ici (i5
APPLICANT NAME: .'J / /:)- tic)4/./ ,60 / L c/o lIVC .
APPLICANT ADDRESS: /3, 0,,66t 2. 10()
G -L7✓idni //. llizi-ei
SEPTIC 1/6ESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: �r(J'iq Keiee-Aj Xi7Cl/Lo/
OWNER MAILING ADDRESS: 2( WrAi004) 'bid
//h()PP/vbr ,NY //78
OWNER PROPERTY ADDRESS: EA &I._, -- NC67- CCU/2 /
TELEPHONE NUMBER OF CONTACT PERSON: Li '7 7-/360
TAX MAP NO. : Section / Z- '7 Block q Lot y
CROSS STREET: 1/01/7-6- L fl /J be/VC-:_
BUILDING PERMIT NUMBER CROSS REFERENCE:
IP1
Signature of Applicant
RECEIVED BY: /ViAL-A-1.4__Q
Town Clerk's Tice
DATE: 6-7-5/ 19
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