HomeMy WebLinkAboutFagan, William OFFICE OF THE TOWN CLERK cvFFObr't,
Town of Southold O •HO "
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road —
P. O. Box 1179
cn �e
Southold,
New York 11971 0 � •-••••
Telephone � d o,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 269 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
PERMIT ISSUED TO:
NAME: William F. Fagan
ADDRESS: P.O. Box 583
Laurel, New York 11948
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling with Cesspool System.
APPROVED as per Suffolk County Health Department approval.
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: William F. and Dolores M. Fagan —
OWNER MAILING ADDRESS: P.O. Box 583
Laurel, New York 11948
OWNER PROPERTY ADDRESS : 9250 New Suffolk Avenue
Cutchogue, New York 11935
TAX MAP NO. : Section 116 Block 4 Lot 3.1
CROSS STREET: Dean Drive
BUILDING PERMIT NUMBER CROSS REFERENCE:
Judith T. Ter
Southold Town Clerk
DATE : December 15, 1987
(TOWN SEAL)
E c _ _ OWED -
• O I 11987
•
BLDG. DEPT. `y
TOWN OF SOUTHOLD _: ' Town Mall, 53095 Main Road
n� � .y' P.O. Box 728
Southold, New York 11971
JUDITH T.TERRY
TELEPHONE
Tov4y CLARK
(516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
DECEMBER 10, 1987
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 272 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by William F. Fagan
Please review the application and location map and advise if the
project has received Suffolk County Health Department approval
and if we may issue the permit.
Please complete the form below and return it to my office.
Thank you.
GAF ✓w--i-►.,""'�'
Judith T. Terry
Southold Town Clerk
* * *
I have reviewed the application and location map of the project
cited above and make the following recommendation:
APPROVE - VC
DISAPPROVE -
COMMENTS: IONIII -ossbegialikamap*Ip25/164t—
A �
�..� Q. _ lisa.siza.G .
RECEIVED
DEC 151987 k 0.40
4.4.Ga..
Town Clerk Southold Signature
I
Date
OFFICE OF THE TOWN CLERK SVFFULj'
JudithTown of T. ythold Town Clerk ��O Cly : Application No. 02
Terry, .t .
Town Hall, 53095 Main Road =: Construction
P. O. Box 1179 J Alteration
Southold, New York 11971
_0 460-6. Residential
Telephone
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee $ ) d OO
DATE p„.. y 7 y f'
/
APPLICANT NAME: I,c/1l iewt F Fgi,?s,
APPLICANT ADDRESS: PQ.. pox 5t?
b 3,.. re 1
, v v
SEPTIC !/ CESSPOOL
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: a id, .2,4 F -PD M Fc7ja4
OWNER MAILING ADDRESS: ?os 1` x �-�
-a� ref, :
OWNER PROPERTY ADDRESS: po25o Surto he Ave
TELEPHONE NUMBER OF CONTACT PERSON: F77 // 9',,P7
TAX MAP NO. : Section /7 Block a ti Lot (00,.?,
CROSS STREET: 2, 7:).--Lx-v-c`‘
BUILDING PERMIT NUMBER CROSS REFERENCE:
..t., 21j
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Signat a of Applicant
RECEIVED BY: w,,�� , _, /l
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