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JUDITH T. TERRY < : Town Hall, 53095 Main Road
TOWN CLERK j P.O. Box 1 179
REGISTRAR OF VITAL STATISTICStin Southold, New York 11971 •
r Fax (516) 765-1823
MARRIAGE OFFICER ® ®� •
�y + �1D � Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 939 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MICHAEL J. & MARILYN HEALION
Address 1 : 29 DALE LANE
City St Zip SMITHTOWN NY 11788
Descripton of Proposed Construction or- Alteration
NEW SINGLE FAMILY DWELLING WITH SANITARY SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 10/20/92.
Name Of Owner HEALION, MICHAEL J. & MARILYN
Mailing Address 1 29 DALE LANE
City St Zip SMITHTOWN NY 11788
Property Address 1 SOUTHVIEW DRIVE
City St Zip ORIENT NY 11957
Tax Map No. section 13.00 block 1 lot 9.000
Cross Street BROWNS HILL ROAD
Building Permit Number Cross Reference:
Issue Date: 11/30/92 Judith T. Terry
Southold Town Clerk
(TOWN SFA' 1
,70 /III��. I
-._ 7 3
, ,
JUDITH T. TERRY
' ® Town Hall, 53095 Main Road
TOWN CLERK ' ® i. P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .N`' Southold, New York 11971
MARRIAGE OFFICER %, ® ;14 Fax (516) 765-1823
_qq r �— - ,, 19 i'' Telephone (516) 765-1801
<< 'ii NOV 2 31992 i , +E; OFFICE OF THE TOWN CLERK
1\ ' Y 1 „ TOWN OF SOUTHOLD
i... BLDG. DEPT.
T'm9V2a OP SOUTHOL-9„ ___0 -
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 23, 1992
Transmitted herewith is a copy of application No. 966 for a Cesspool/
Septic Tank Construction Permit submitted by:
Michael J and Marilyn Healion --- --
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office r
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 4( -
DISAPPROVE
Comments: a� ,,,c)L•tc.. a M C15. , LCt-TrAPEfila
) Co. 'al a, A 1 011.b\t �.
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Signature `
4S\c\ .....
Dated
OFFICE OF THE TOWN CLERK ,cvrFUL{'(;'
Town of Southold w G 96P
Judith T. Terry, Town Clerk +� 34
Application No. fp
Town Hall, 53095 Main Road o 1•} +- Construction L"
'• P. O. Box 1179 ��� " '=>_
Southold, New York 11971 •
' r , ' Alteration
Telephone 01 r ���i� Residential
•(516) 765-1801 n
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
•
DATE 11,1q1q47
APPLICANT NAME: Wag!" .1. po
APPLICANT ADDRESS: /A Pot
5141 tJ 111W
SEPTIC / CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
elmter pco SI ALt rAti!uu).11 Pg 6fp
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: H164110, J, tifkoo PAiiionu limbo
OWNER MAILING ADDRESS: Oa atilt LAM
AblirritiPli 01 1111W
OWNER PROPERTY ADDRESS: SD( 1�I6 IV�i
tP1 it
TELEPHONE NUMBER OF CONTACT, PERSON: 242-02W
TAX MAP NO. : Section ®t Block Lot P® q
CROSS STREET: ibeou,Vc, iu, j®l'd
BUILDING PERMIT NUMBER CROSS REFERENCE:..
A. 141•401,
nature .1 A licant
r
RECEIVED BY:
Town Clerk's Office
DATE:
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-- ' STATEMENT OF INTENT'
�' �� � . 90-: = I :QR.–At—Er
� �EN_r, _. c THE WATER SUPPLY AND SEWAGE DISPOSAL
•
, `�. •c ' - I�$:$, `0 ` CJ,�E�C � ' ' N.Y., •
SYSTEMS FOR THIS RESIDENCE WDLL
'r �.� \ ,-r. r "-'-- - '0- - CONFORM TO THE STANDARDS OF THE
• y' t \, ,' •�;Q •L SUFFOLK CO. DEPT. OF HEALTH SERVICES.
� ��" APPLICANT
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ID \ ' \_ �� C4":14:'''''''''.
�` \ SUFFOLK COUNTY DEPT. OF HEALTH
4's \ SERVICES CES — FOR APPROVAL
,` % n7 \ C7� CONSTRUCTION ONLY ;
�`` :1 4- �. H.S.REF.NO.•
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APPROVED: r /�t0
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�1 y 8$ • SUFFOLK CO.TAX MAP DESIGNATION:'
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