HomeMy WebLinkAboutFormica, Louis ,��
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JUDITH T.TERRY ` o= Town Hall,53095 Main Road
TOWN CLERK t y Z P.O.Box 1179
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REGISTRAR OF VITAL STATISTICS In �, Southold,New York 11971
Fax(516)765-1823
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MARRIAGE OFFICER =** Q��i��
RECORDS MANAGEMENT OFFICER : 1 ..0� Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1396 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LOUIS & ELIZABETH FORMICA
Address 1 : 51 STEERS AVENUE
City St Zip NORTHPORT NY 11768
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. #R10-94-0011
Name Of Owner FORMICA, LOUIS & ELIZABETH
Mailing Address 1 51 STEERS AVENUE
City St Zip NORTHPORT NY 11768
Property Address 1 2422 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 114.00 block 7 lot 10.006
Cross Street SOUND AVENUE
Building Permit Number Cross Reference:
Issue Date: 9/27/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY C Town Hall,53095 Main Road
TOWN CLERK t v3 at P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ‘`0 ��rrt , Southold,New York 11971
Fax(516)765-1823
MARRIAGE OFFICER �y� a0��►►
RECORDS MANAGEMENT OFFICER : 0.( * Telephone(516)765-1800
FRTEIOO' P ^'e ',fir it • 'OFFICER -.,... ,,�•
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SEP 2 1995 OFFICE OF THE TOWN CLERK
.,. TOWN OF SOUTHOLD
BLDG. DEPT
TOU
WN OTHO+
.111 Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 22, 1995
Transmitted herewith is a copy of application No. 1449 for a Cesspool/
Septic Tank Construction Permit submitted by:
Louis and Elizabeth Formica .
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
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I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE v
DISAPPROVE �-
Comments: .,lam ,,P',.� kg o -- Cl ii....--- OQ !/ `c-''v
Sig --Lir, of
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Dated
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OFFICE OF THE TOWN CLERK ,,,'""
-town of Southold /t'�itf OIK - /
- Judith T. Terry, Town Clerk ,''�0� Application No.) (1:4
Town Hall, 53095 Main Road ;�� Construction
P. 0. Box 1179 Alteration
Southold, New York 11971 c�t� ��
Telephone 0 �_��' $10.00 - Residential s/
(516) 765-1801 44)1 '�
' $25.00 - Non-Residential
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TOWN OF SOUTHOLD ��lt`�' �" Clerk
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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APPLICATION
for
CONSTRUCTION or eL ThRnTION PERMIT•
SEPTIC TANK
Permit No.
Fee $ (0,p0
DATE 5-e�j-vim � 21� vs
APPLICANT NAME: / E(LjJ 1tY*1.C9
APPLICANT ADDRESS: 61 Seers A.
/CESSPOOL AA04110 Aqv 117 a
SEPTIC 1
• DESCRIPTIONOFPROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Lett* awi 61122 [' yh tca
OWNER MAILING ADDRESS: 51 Steekts Ave.
[1bitk?o4/N%\i. 117 623
OWNER PROPERTY ADDRESS: vt.2.246464 pe,
MAtunk. A'I'I
TELEPHONE NUMBER OF CONTACT PERSON: (51) 7S7-ib?9 (touts Vysitca)
10 00
TAX MAP NO. : Section t([f. Block .67 Lot /O„(,
CROSS STREET : �dc.tKc1ytkee.-
BUILDING PERMIT NUMBER CROSS REFERENCE:
.,' ..., 45c/Aiti-e-ot,
Oir S gnature of Applicant
RECEIVED BY : U/1/(44-----
own lerk's Office
DATE: /aQ'g- e- '
-EXAMStie YEARS FACHtDATEWiiPPRC)VAL
e
o a - ''
:` STATEMENT OF INTENT
^4.; �,51- d4•4 r1� ` '_ `• fr- , �1 THE WATER SUPPLY AND SEWAGE DISPCSXL
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' - ? '��' !,— SYSTEMS FOR THIS RESIDENCE WILL
CONFORM TO THE STANDARDS OF THE
c� � --- / SUFFOLK CO. DEPT OF HEALTH SERVICES
', ',��' ��'` -c e 'S' APPLICANT
qe i' � —� sir SUFFOLK COUNTY DEPT. OF HEALTH
ate`' �' ~�'� �, - SERVICES — FOR APPROVAL FOR
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~~~ moa f` �� CONSTRUCTION ONLY �j
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A �• '"' c� H. S. REF. NO. l b
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, 'fir ." APPROVED
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f /' SUFFOLK CO. TAX MA IGNATION.
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