HomeMy WebLinkAboutKitz, Charles •
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ELIZABETH A.NEVILLE � y oGy�R Town Hall, 53095 Main Road
TOWN CLERK c -‘ Z, P.O. Box 1179
N Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Pr,
Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER4.41 91 jlig ���� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER r
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2012 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CHARLES & MARGUERITE KITZ
Address 1 : 110 RANDALL ROAD
City St Zip SHOREHAM NY 11786
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 #R10-96-0068
Name Of Owner CHARLES & MARGUERITE KITZ
Mailing Address 1 110 RANDALL ROAD
City St Zip SHOREHAM NY 11786
Property Address 1 EAST SIDE AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 3 lot 21 .002
Cross Street BAILIE BEACH ROAD
Building Permit Number Cross Reference:
Issue Date: 2/18/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABE ' • itAL�1 \ t ti..`' Town Hall, 53095 Main Road
TOW 1 • 9 P.O.,1\ ';;= 1 Box 1179
1� LL �p� t t Z Southold, New York 11971
REGISTRAR OF .T \ SSTItS17"' ^„ Pr, Fax MARRIAe' 'O ICER 1 Fax (516) 765-1823
RECORDS MANA EM lk • . :i' T Z%y,#Q aV- 1� Telephone (516) 765-1800
FREEDOM OF INFORMATION i' '}TOLD_ % * �`.•
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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: February 17, 1999
Transmitted herewith is a copy of application No. 2092 for a Cesspool/
Septic Tank Construction Permit submitted by:
Charles & Marguerite Kitz .
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
DISAPPROVE
Comments:
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OFFICE OF THE TOWN CLERK " �UFFOIKc
TOWN OF SOUTHOLD ;' 4. Application Not._. ° 0-,
ELIZABETH A.NEVILLE,TOWN CLERK �j,,
P.O.BOX 1179 !�t Construction
SOUTHOLD,NEW YORK 11971
::1 Alteration
Telephone y0,j �Q���/ $10.00 -Residential
(516) 765-1801 - 1 4�,,�'� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT "V"e'n'e'R'!
SEPTIC TANK or CESSPOOL r ; ? f^
1999
town Glcrlc wuthold
Permit No.
Fee $
DATE /-8 kvi}g y 7, /q99
APPLICANT NAME: eti ,s-s d- MAR.6Uc01FE. K r+2-
APPLICANT ADDRESS: 110 kJ) . S t'1Og_okit, i
7gc„
SEPTIC X CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
ithAv 6A,srp-c,c riira /47 /3 we-fit
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: C1?
OWNER MAILING ADDRESS: 1 i 0 R NDA-L- . kb .
S N. i17 6
OWNER PROPERTY ADDRESS: ci OE.. NE-
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TELEPHONE NUMBER OF CONTACT PERSON: Iter- 32(-3637 &fewer 929-8n,
TAX MAP NO. : Section Block S Lot ar.),
CROSS STREET: RAIL) Re-Act/ vott_m
BUILDING PERMIT NUMBER CROSS REFERENCE:
Ctiodips- Ai ' 40
i
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"ai gnature o A I . icant
RECEIVED BY:
Town Clerk's Office
DATE:
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ESUCTUARE
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REFS, ADDITION TO BUILDINGS INSTITUTION. GUARANTEES ARE MAP OF OREGON HEIGHTS
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INSTITUTIONS OR SUBSEQUENT
NAUTrIORIZED ALTERATION OR OWNERS. SITUATED AT M AT T I TV CK
ODITION TO THIS SURVEY IS A
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CE NEW YORK STATE EDUCATION BEARING THE LAND SURVEYOR'S TOWN OF S O U T HOLD , SUFFOLK COUNTY ,N Y -
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,•-k TO BF SCALE 1" = 60' DATE 7 - 15 - 1 596
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:UARANTEED ONLY TRANo 0Z TAX• MAP 'N O. 1000.99-31.•41.2. rel.only d I s k 154
,� 0A�„1 s HAROLD F. TRANCHON 1R. P.C.
I ;_ LAND 'SURVEYOR
rt• I . SUCCESSOR TO WILLIAM G. MEIER
<,-�4 / 4, 91'Oji 992 a��� NORTH COUNTRY ROAD - WADING RIVER
F / • 1. . vP NEW YORK 11792
A OLD F. TRANCHON 1R. IC• NO. 048992 (51'6) 9"29•.4695
PENN. LIC. NO. 21115-E