HomeMy WebLinkAboutFord, John OFFICE OF THE TOWN CLERK C��FFU(�`,"
Town of Southold �� 4lj
Judith T. Terry, Town Clerk `:
Town Hall, 53095 Main Road
P. O. Box 1179 112 `
New York 11971
Southold,
Telephone - 0l i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 19 Residential XX
Fee $ 10.00 Non-Residential
Septic Cesspool XX
PERMIT ISSUED TO:
NAME: John T. Ford
ADDRESS: 5 Leeland Drive
Hauppauge, New York
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New system for new one family dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: John T. Ford
OWNER MAILING ADDRESS: 5 Leeland Drive
Hauppauge, New York 11788
OWNER PROPERTY ADDRESS: Ruth Road, Extension
Mattituck, New York
TAX MAP NO. : Section 106 Block 01 Lot 1. 11
CROSS STREET: Sunset Drive
BUILDING PERMIT NUMBER CROSS REFERENCE:
Judith T. Terry
Southold Town Clerk
DATE : August 28, 1986
(TOWN SEAL)
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p ` �`� Town Hall, 53095 Main Road
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y'�'� ,;,�i�'� Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 28, 1986
•
John T. Ford”
5 Leeland Drive
Hauppauge, New York 11788
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic"Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10.00) for
residential use and twenty-five dollars ($25.00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly yours,
eogtea;:;ee„:,..........;„.0----”
,..01, c..../.0-7.----
Judith T. Terry
Southold Town Clerk
Enclosures (3)
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0 M S; Town Hall, 53095 Main Road
'dol ,AZtA P.O. Box 728
Apt 'X° Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 14 , 1986
To : Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 18 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by JOHN T. FORD .
Please advise if the project has received Suffolk County Health
Department approval and if we may issue the permit .
u ith T. Terry
Southold Town Clerk
Attachments
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OFFICE OF THE TOWN CLERK
Town of Southold /
,
Judith T. Terry, Town Clerk Application No.
Town Hall, 53095 Main Road Construction
P. O. Box 1179
Southold, New York 11971 Alteration
Telephone 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 $ /', OO
DATE 7/R,4181,
APPLICANT NAME: J ow.) T. coe.
APPLICANT ADDRESS: S Lett-pkn.
QPcs.u.�B feu, 1 - i: ,I1ifY
i
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
l'A E t,J �ct_ tte, e
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 3 & �, qoet,
OWNER MAILING ADDRESS: S �EELAAk itsw
406,- PPaue N10,,t 11.71
OWNER PROPERTY ADDRESS: Rk44. RRA►.
H*41.144.,,k 4wt.
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TELEPHONE NUMBER OF CONTACT PERSON: .S-A, - lay- ` 41O 7a'/- 7 I34
TAX MAP NO. : Section )O(, Block 01 Lot I. ! I
CROSS STREET: - u r\ c-i �Q Ji✓
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature f Applicant
RECEIVED BY:
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DATE: � /y/e ;
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EXP‘Vk (VACANT)
SURVEY FOR
SU?FOUC COUNTY DEPARTMENT OF HEALTH sERVICE!• JOHN t FORD & ARLENE T. FORD
FOR APPROVAL OF CONSTRUCTION ONLY AT MATTITUCK
r tisaci TOWN OF SOUTHOLD
DATE 71 1 s REF. NO. & ' SQ 13CI SUFFOLK COUNTY, NEW YORK
*UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTEED T
4PPROVED NEM YORK STATE EDUCATION SECTION
A%ON 720f OF THE GUARANTEED
COMMONWEALT:
N COPIES OP THIS SURVEY NOT SEARING THE LAND JOHN T.FORD a
p� y SURVEYORS INKED SEAL OR ENROSSED SEAL SHALL
1 ,,,L..„...10NOT DE CONSIDERED TO RE A VALID TRUE COPY
�'"""� -��._. N GUARANTEES INDICATED HEREON SHALL RUN ONLY 10 y
I HtALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR�+!rw1.111011 _.
THE SURVEY IS PREPARED '