HomeMy WebLinkAboutSmith, Maureen APO
0 ' OFFO(,-
ELIZABETH A.NEVILLE y� l/y Town Hall, 53095 Main Road
TOWN CLERK P.O.P.O. Box 1179
ivp �Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER �Oy � �� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER '. �l * '0„10
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2017 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MAUREEN SMITH
Address 1 : 465 TOWN HARBOR LANE
City St Zip SOUTHOLD NY 11971
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 #R10-99-0012
Name Of Owner SMITH, MAUREEN A
Mailing Address 1 465 TOWN HARBOR LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 465 TOWN HARBOR LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 63.00 block 4 lot 7.000
Cross Street COUNTY ROAD #25
Building Permit Number Cross Reference:
Issue Date: 3/01/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE , . l/y Town Hall, 53095 Main Road
TOWN CLERK < P.O. Box 1179
0
ti �Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Z� �' Fax (516) 765-1823
MARRIAGE OFFICER T -
RECORDS MANAGEMENT OFFICER . �f /O r--
� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER 11'� Jig r r
OFFICE OF THE TOWN CLERK ., 5 IQO
TOWN OF SOUTHOLD lw LI
TO: Southold Town Building Department .fir, ___ n
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 24, 1999
Transmitted herewith is a copy of application No. 2097 for a Cesspool/
Septic Tank Construction Permit submitted by:
Maureen A. Smith .
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 re mmendations:
APPROVE
DISAPPROVE
Comments:
ignatur
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Dated
OFFICE OF TIE TOWN CLERK """'CA�Futk;
TOWN OFSOUTHOLD ,' CSG= Application No. 77
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 : Construction
SOUTHOLD,NEW YORK 11971 a
Alteration
Telephone = �'yit, $10.00 - Residential
(516) 765-1801 .. Ol .° $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION Breen em
FEB 2 4 1999
for
CONSTRUCTION or ALTERATION PERMIT lown Clerk Southold
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE I E Q, 2-3, fft\
i
APPLICANT NAME: 1.t`'eei7 4.
APPLICANT ADDRESS: 1166" 1/1j JJ9 �Gzrt' 'LCc4
/1<y. • i/ g
SEPTIC / CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
02 S1oR go.,( wiTti MoenPodl-c4 wR�+ Ii vs„ (2- 644)
Al.1�21•{lsl b k LI stn e DoDR ( 23 rat
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ,7&/-L-ems'/? 41. (5-41//h
OWNER MAILING ADDRESS: 1/6c 7(;a)4 /1%/-.ho/ dill i
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OWNER PROPERTY ADDRESS: 5/9-ni�
TELEPHONE NUMBER OF CONTACT PERSON: 9-6 5-- ,3O0? 7
TAX MAP NO. : Section 63 Block Lot
CROSS STREET: ( Noyti,T , aS' (MAIN SIC)-66-1
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of ppl cant
RECEIVED BY :
TowngClerk's Office
DATE: p! ( ,1 I
. . . . .. ..
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SURVEY OF PROPERTY
.-- . ..-,,,, CERTIFIED TO:
SITUAM:SOUTHOLD - ,`',.. JOHN G.SMITH
TOWN OF SOUTHOLD 0, c, ,, . - EN SMITH
v (5)- e-4 Is
SUFFOLK COUNTY, NY
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SURVEYED 06-21-c16 •6lf,-*>
AMENDED 0I-I2-ctq ti-1
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SUFFOLK COUNTY TAX#
1000 -63 - 4 -/ .--,
MAIN ROAD — S.R. #25
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COUNTY TOPO MAPS
N.Y S. LIC. NO 50202
JOHN C EHLERS LAND SURVEYOR
GRAPHIC SCALE I"= 30' 6 EAST MAIN STREET
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