HomeMy WebLinkAboutFigurny, Laura iii.�•-
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JUDITH T.TERRY ` % Town Hall, 53095 Main Road
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TOWN CLERK H Z ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS sa4111 `1►a Ol.F• Southold,New York 11971
MARRIAGE OFFICER ,t,0Fax(516)765-1823
RECORDS MANAGEMENT OFFICER __'�1 �� Fax
(516)765-1800
FREEDOM OF INFORMATION OFFICER 1.°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1340 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LAURA A. FIGURNY
Address 1 : 360 FISHEL AVENUE
City St Zip RIVERHEAD NY 11901
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-95-0037
Name Of Owner FIGURNY, LAURA A.
Mailing Address 1 360 FISHEL AVENUE
City St Zip RIVEREHEAD NY 11901
Property Address 1 1525 BERGEN AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 112.00 block 1 lot 16.007
Cross Street SOUND AVENUE
Building Permit Number Cross Reference:
Issue Date: 6/01/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
1,,,,,o��FFOLkcOGy
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JUDITH T. TERRY < ; Town Hall, 53095 Main Road
TOWN CLERK =o T 4 P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS . ' Southold, New York 11971
�. � Fax (516) 765-1823
MARRIAGE OFFICER = .,/' �40—
$ Telephone (516) 765-1801�
RECORDS MANAGEMENT OFFICER ,►.
FREEDOM OF INFORMATION OFFICER ,,,""�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department Ic'Q
FROM: Linda J. Cooper, Southold Town Clerk's Office
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DATED: May 23, 1995
Transmitted herewith is a copy of application No.1389 for a Cesspool/
Septic Tank Construction Permit submitted by:
Laura A. Figurny
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.
�,c�c.eGcv
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE Q
Comments: y,ee,,- Qf �Q4 V/1 /D 99S=od,3 7
REcINED �--
S gnatur'
MAY 3 1 1995 5, e7S-
t0wn Clerk &Wad Date
s/°n`
OFFICE OF THE TOWN CLERK
Tbwn of Southold r' �FFOlK
Judith T. Terry, Town Clerk � COl/ Application No./S813`
Town Hall, 53095 Main Road
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P. O. Box 1179
_
Southold, New York 11971 s ifs W$ Alteration
Telephone 0 ��O��i', $10.00 - Residential / / —
(516) 765-1801 . 1 1 �'
...,,0 $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 71,24, ,% fr ( --
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APPLICANT NAME: /) T/ C 'ti�
APPLICANT ADDRESS: 3(,,c r / //t
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: 1.../-/c/Aft) /1 F/660/214
OWNER MAILING ADDRESS: „9:‘,0 t/.5/t2,
OWNER PROPERTY ADDRESS: /S 2 13'9:66.-Ai
HS/7/ Tuc/( /J-/ //c/C2 -
TELEPHONE
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TELEPHONE NUMBER OF CONTACT PERSON: ,j [ let)
TAX MAP NO. : Section 1/7 S% Block //i- Lot - / - /(• 1
CROSS STREET: .`c.a(i))
BUILDING PERMIT NUMBER CROSS REFERENCE:
�..._.. / "_/
Signature of Applicant
RECEIVED BY: //t/j/( p
Town Clerk's Office
DATE: s , ,/Q
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10 N A C.C I CONSULT INC ENGINEERS/SURVEYORS/PLANNERS C VIOL A
• 11YMAN & 175A Commerce Drive,Hauppauge,NY 11788 • cvJE LP t 4I `�� n IC: Y ,t.'
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