HomeMy WebLinkAboutWellin, Nancy Lee .
,it OF FOL
ELIZABETH A.NEVILLE .Z�\ t‘N Town Hall, 53095 Main Road
TOWN CLERK c -� r P.O. Box 1179
4 ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �'I Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER ‘,0 47'
�O�'1�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
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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. 2022 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : HARBOUR MEADOWS PRESERVATION
Address 1 : BOX 804
City St Zip ST JAMES NY 11780
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 #R10-98-0182
Name Of Owner WELLIN, NANCY LEE
Mailing Address 1 1024 OAK CHACE DR, APT 0
City St Zip TUCKER GA 30084
Property Address 1 GRAND AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 107.00 block 8 lot 37.000
Cross Street BROWER ROAD
Building Permit Number Cross Reference:
Issue Date: 3/02/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
,e figtFFOLA,
ELIZABETH A.NEVILLE ,�.Z�� Gy�$ Town Hall, 53095 Main Road
TOWN CLERK < P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N = Southold, New York 11971
MARRIAGE OFFICER ` • Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER :y � Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER � � ��"
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 1 , 1999
Transmitted herewith is a copy of application No. 2103 for a Cesspool/
Septic Tank Construction Permit submitted by:
Harbour Meadows Preservation Co. Ltd. , for Nancy Lee Wellin
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 mendations:
APPROVE
DISAPPROVE
Comments:
ignature
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Dated
`C a/ off
OFFICE OF THE TOWN CLERK ,t'� `1 O�K
TOWN OF SOUTHOLD %`'Z ) C�G� Application No.
ELIZABETH A.NEVILLE,TOWN CLERK G�
P.O.BOX 1179 Z; Construction
SOUTHOLD,NEW YORK 11971 p ; A l to ra t i o n
Telephone y�Ace �Q . $10.00 - Residential 1
(516) 765-1801 .1l �', $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 ':3?— 1 — 5/
APPLICANT NAME: / QtJV L (f 9 '6 k)S /'/ ?$�-tL1p,✓ C p
APPLICANT ADDRESS:'U X c-
SEPTIC -_ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION / / 'fl1 L 5-1
/Cs/?E,1 t
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Q C ( 1.2 u-' e- (ii��
OWNER MAILING ADDRESS: / O 2i Cafe_ [� �� 9i2.C. ' c
CA 00
OWNER PROPERTY ADDRESS: / NC-'1) Lam( i,U 1=L L i //(
,V6OC /l977_r T
TELEPHONE NUMBER OF CONTACT PERSONc �t� AC, Tr-L, —c/6
TAX MAP NO. : Section /0 /.7 Block 0 F Lot "37
CROSS STREET: 6,e4),p
BUILDING PERMIT NUMBER CROSS REFERENCE: �-
Signaturflee6Y:.‘
ofcant
RECEIVED BY: d- /
Town Clerk'sice
DATE: � � /9e,
11
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TEST HOLE DATA
Sd ct (TEST HOLE DUG BY McDONA10 FOSOIFAv-F ON NOVEMBER 17, 1998) SURVEY OF
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*ELL S.C. TAX No. 1000-107-08-37
42
DECEMBER 7, 1998
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JANUARY 19, 1999 REVISED PLOT PLAN
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{ t IOP�E reap n No 9 • �� AREA = 33,750.00 sq. k.
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