HomeMy WebLinkAboutTerry, Mark oll'OFFOLA,
ELIZABETH A.NEVILLE t y t= Town Hall, 53095 Main Road
TOWN CLERK ; c P.O. Box 1179
N 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER $ Fax (516) 765-1823
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RECORDS MANAGEMENT OFFICER 1Telephone (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. 2019 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MARK & BONNIE TERRY
Address 1 : 1415 4TH STREET
City St Zip NEW SUFFOLK NY 11956
Descripton of Proposed Construction or Alteration
ADDITION OF CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner TERRY, MARK & BONNIE
Mailing Address 1 PO BOX 87
City St Zip NEW SUFFOLK NY 11956
Property Address 1 1415 4TH STREET
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 7 lot 3.000
Cross Street ORCHARD STREET
Building Permit Number Cross Reference:
Issue Date: 3/02/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
�#01 OfFO[�-�; F
ELIZABETH A.NEVILLE �.Z�� �tTown Hall, 53095 Main Road
TOWN CLERK Z c 1 ''>`, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
N �2 Southold, New York 11971
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER '"._1% 0 0 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER 0I * ',i'
..,, ,-ISI
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 1 , 1999
Transmitted herewith is a copy of application No. 2099 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Mark and Bonnie Terry •
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
0
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the followi recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
n
Sign ure
311 j q 01
Date
ar p ,,,,,s,,.__,_
OFFICE OF THE TOWN CLERK ,1" s��fULK
TOWN OF SOUTHOLD k,'Z 6G Application No.320� �l
ELIZABETH A.NEVILLE,TOWN CLERK ���,,,,,,
P.O.BOX 1179 t Construction
SOUTHOLD,NEW YORK 11971
Alteration L�
Telephone O�� �Q��i� $10.00 - Residential C�
(516) 765-1801 = ".� l 0'� $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 *9-4/i /99y
APPLICANT NAME: /, ,86,,v4//6-,8 ,,U4/i6- "76'�QrQ y c.)vleK �Y
APPLICANT ADDRESS: KrCG�
�l/S y,a STT'6-6 i
/1/F_w QOTFoLGf
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
A7/Z--4 C X/57/'A'6 5Ss/60G
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: / ///r /a ST. 66
OWNER MAILING ADDRESS: ,P D,/ C �7
/t/Ew SOF/O
OWNER PROPERTY ADDRESS: ,4y94PGr .f ,o/JN/*6- �e-/q•
TELEPHONE NUMBER OF CONTACT PERSON: 7?V-5..256
TAX MAP NO. : Section /17 Block 7 Lot_3
CROSS STREET: 01(-'Cy4I7 7 ST
BUILDING PERMIT NUMBER CROSS REFERENCE:
/749"IZe- /-/- 1t7
Signature,T Applicant
RINalleu
RECEIVED BY:
MART9nn f rk's Office
DATE: