HomeMy WebLinkAboutForbes, Susan ,,,,,IIII .i
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JUDITH T. TERRY t : Town Hall, 53095 Main Road
TOWN CLERK v T P.O. BOX 1179
REGISTRAR OF VITAL STATISTICSIrS Southold, New York 11971
MARRIAGE OFFICER ‘="40A. O�' ��, Fax (516) 765-1823
•thn1 + PDrr r Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1051 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SUSAN FORBES & CLAUDIA SLACIK
Address 1 : 1075 NARROW RIVER ROAD
City St Zip ORIENT NY 11957
Descripton of Proposed Construction or Alteration
ADDITION OF RING TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED DISTANCES FROM ADJACENTS
WELLS, BUILDINGS AND PROPERTY LINES. EXCAVATION INSPECTION REQUIRED.
Name Of Owner FORBES, SUSAN
Mailing Address 1 SLACIK, CLAUDIA
City St Zip 0000
Property Address 1 1075 NARROW RIVER ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 27.00 block 3 lot 6.002
Cross Street KING STREET
Building Permit Number Cross Reference:
Issue Date: 10/27/93 Judith T. Terry
Southold Town Clerk
[TOWN SEAL)
146. �FfOLKC �(;
SIT :0A
JUDITH T. TERRY ;,1= Z Town Hall, 53095 Main Road
TOWN CLERK O T P.O. Box 1 179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765 1823
MARRIAGE OFFICER �Q O�' ��
'�1 .�1D o�� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office;_
DATED: October 6, 1993
•
Transmitted herewith is a copy of application No. A1082 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Susan Forbes and Claudia Slacik
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.
Linda J. Cooper
•
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
EXCAVATION INSPECTION
DISAPPROVE - REQUIRED
COMMENTS: 124:144,4 ,<44-€4,04, /1,0-71.2
.elep;.A-6 e- /f/. e.42 20'?-itif %fie-Z-1.
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Signature
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Date
•
` OFFICE OF THE TOWN CLERK CLrf
Town of Southold ,,07
Judith T. Terry, Town Clerk ,._ ;-/- 7..:1‘;
i;r" � Application No/061-2
Town Hall, 53095 Main Road
P. O. Box 1179 cri t'.•' .c+ F- Construction
Southold, New York 11971 • 4,'( r,
�` �`} • Alteration i—
Telephone "°t ff< �1� Residential
(516) 7G5- 1301 . „if
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TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
•
•
APPLICATION
•
. for •
• ,
CONSTRUCTION or ALTERATION PERMIT
•
SEPTIC TANK or CESSPOOL
•
Permit No.
Fee .$ /)
DATE d - y
APPLICANT NAME: S v ).9a
�A c� •
APPLICANT ADDRESS: a 7
•
SEPTIC CESSPOOL / -
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION '
- 0: S ie o^J p ">(/ Y /N G
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LOCATION MAP: • Must be attached hereto before permit maybe
issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• OWNER OF PROPERTY: fGyA,,,
• OWNER MAILING ADDRESS: .
OWNER. PROPERTY ADDRESS:
j,
• -7- . Y / 95- 7
\ TELEPHONE NUMBER OF NTACT : ,/t`s ERSON • 41 � ��
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TAX MAP NO. : Section Z 7 , Block O 7 Lot G
, Z
CROSS STREET:
G
BUILDING PERMIT NUMBER CROSS REFERENCE:_.
•
•
, /
• Signature of Ape, icant
•
RECEIVED BY: ` .e.._.�Q
Town C V �er•k's-Office
DATE: 4.,
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