HomeMy WebLinkAboutForchelli, J D ,
a
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in � Town Hall, 53095 Main Road
-_V ,,O P.O. Box 1179
1 "'r,°' Southold, New York 11971
JUDITH T.TERRY —.-', ,,'0 FAX(516)765-1823
TOWN CLERK TELEPHONE(516)7654801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 620 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : CATHERINE MORRELLY
Address 1 : 14 GREENHAVEN WAY
City St Zip CENTERPORT NY 11721
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND 'AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 6/5/90.
Name Of Owner FORCHELLI, J.D. & MORRELLY, C.
Mailing Address 1 14 GREENHAVEN WAY
City St Zip CENTERPORT NY 11721
Property Address 1 LONG CREEK DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 55.00 block 7 lot 4.000
Cross Street LAUREL ROAD
Building Permit Number Cross Reference:
Issue Date: 6/26/90 Judith T. Terry
Southold Town Clerk
___ __ (TOWN SEAL)
t Town Hall, 53095 Main Road
P.O. Box 1179
/t a_ -%*" Southold, New York 11971
JUDITH T.TERRY „,���; TELEPHONE
TOWN CLERK5161 76S-1801.
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK L M O W
TOWN OF SOUTHOLD i
\ I JupI191960
13
To: Southold Town Code Enforcement Officer i iLL.2
BLDG. DEPT.
From: Linda Cooper, Southold Town Clerk's Office TOWN OF SOUTHOLD
Dated: June 19, 1990
Transmitted herewith is a copy of application No. 635 for a Cesspool/
Septic Tank Construction Permit submitted by:
C. Morrelly
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: v,, 1,.., � A►. o�OG. � .lin. '!.
U—AtS.�.t� >. LP\ .-\q6
RECEIVED \(.1 a'u.,, at-a-0 w.
Signature
JUN 21 z► CIO
Dated
Town Clerk Som
/
OFFICE OF THE TOWN CLERK VFFQ
Town of Southold ��0� �� Application No. C�-3 5 -
Judith T. Terry, Town Clerk 1
Town Hall, 53095 Main Road 'M Construction v
P. O. Box 1179 0 . , *.$ Alteration
Southold, New York 11971
Telephone #401 4 'Ns' •' Residential ✓ _
(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 $ /(j _P" /
DATE 6 _ / 9 - 96-)
APPLICANT NAME: ( LL7
APPLICANT ADDRESS: / 66 °�--47&iggde-� alg
-7 y
(>=V e,e,20 re 7- /y
SEPTIC CESSPOOL-------
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
2S406"
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: J b_ , o,eL-,LLi @.ge,,,e,2 LIJ
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: E0i06 (,ec- .e .g+C:)s
c?T/ L6
TELEPHONE NUMBER OF CONTACT PERSON: ;7,,,n--7- 6k57�
TAX MAP NO. : Section 2i Block 7 Lot 3/
CROSS STREET: .49C.t,,E't L A iS .
BUILDING PERMIT NUMBER CROSS REFERENCE:
'')
Signature of A lican
�j � 9 p P
RECEIVED BY: /b�
Town Clerk's Of ice
DATE: 6 ---/ - --- 9 Rle
• .
. . .
.. • SUFFOLK CO. HEALTH DEPT. APPI
MAP OF.CONG Pomo, ESTAT E-S- 5 ECT, Ofqe, _ .
H. S. NO.
fAAP. OF PROPERTY
rez: Co CLEOCS OFFICE .
SURVEYED P '12
..
A RS F-1&MO frIAQUE ' POND
1‘EN CATHE12NE M01212E1 LY
Kr
iv Ltwe.PET2-C1LZD' MAP STATEMENT OF INTENT
, w /.."
N.74.38 30. ------E. , I 44.q2 ‘ SOUTHOLD THE VVATER SUPPLY AND SEWAGE 0
2 .. vArrtit,...., to,likatl...." .., .2. 117,41/4/1•1 OF '50.171-4 Q LC), NY, • ‘ SYSTEMS FOR THIS RESIDENC
CONFORM TO THE STANDARDS
SUFFOLa _it i_) /DEPT.. 0 Oltok H SI1
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4 '-6- • -->".'17 t 8 1.- ---- / 1/ APPLICANT
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, ..- 1.7 \ ) NI SERVICES - FOR APPROVA1
CONSTRUCTION ONLY
,
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H. S. REF. NO.: ...0 ----, (
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, <I APPROVED: 4111PgaWt ,....
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>tij N.% LU 14 GREEM-IAVEN WAY
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