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JUDITH T. TERRYz Town Hall, 53095 Main Road
TOWN CLERK ® T • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
V.
MARRIAGE OFFICER ®�' ''� Fax (516) 765-1823
• Jfig,y®� �1D ��� Fax
(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. 1102 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN A. HOFER
Address 1 : 25 EAST SIDE AVENUE
City St Zip MATTITUCK NY 11952
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 #R-10-94-0008
Name Of Owner HOFER, JOHN A.
Mailing Address 1 25 EAST SIDE AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 HARBOR LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 97.00 block 6 lot 12.004
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 4104194 Judith T. Terry
Southold Town Clerk
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,, ® Town Hall, 53095 Main Road
JUDITH T. TERRY -
z P.O. Box 1179
TOWN CLERK ® rra
W Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �� Fax Fax (516) 765-1823
MARRIAGE OFFICER �b .,�� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER : ®,� 144.#.°°
FREEDOM OF INFORMATION OFFICER ': �„i,L,, °��
OFFICE OF THE TOWN CLERK ---) 12-= ' '
TOWN OF SOUTHOLD ° =-, +
,1 MAR S i 411994 ki
ti ik '1
1131.1i
TO: Southold Town Building Departmentn~`� -
FROM: Linda J. Cooper, Southold Town Clerk's Office i'9141
6 :°ii 1"p42l_°
DATED: March 11, 1994
Transmitted herewith is a copy of application No. 1138 for a Cesspool/
Septic Tank Construction Permit submitted by:
John A. Hofer
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: SC ii) ,/e
egi® --- 9,4"-- a 8® ,
,d11 111 k
REEVE
MAR a 1-1994
Signatur- /
,
Town Clerk Southold
Dated
::tee e. .
OFFICE_ OF THE TOWN CLERK 1
Town of Southold Q�`'r`� r' �-
-lodith T. Terry, Town Clerk ,.._• ':.) �` `Oi r•
Town Hall, 53095 Main Road i.'- .� Application No.
moi:. "—. � �' // $`.
P. O. Box 1179 • . Fit....U' ii ' Construction ��Southold, New York 11971 O., ,�, . moi- r __________
•
� , ��- Alteration
Telephone _ O ��
(516) 7G5- 130T 1 �b s� Residential:
Non-Residential
•
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
•
APPLICATION
•
for
•
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE Rhe // //
APPLICANT NAME: C 0/ /0 /4 (e=.,-/0/2:4-/a.
APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: - Must be attached hereto before
permit may be issued.
LOCATION! OF PROPOSED
CONSTRUCTION OR TERATION:
OWNER OF PROPERTY: 0/ /4rirl '
OWNER MAILING ADDRESS: • l
1 E-04:j T_s t i__ _ 4./e_ -
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: _ G.
TAX MAP NO. : Section 97. Block
Lot /2 P
. CROSS STREET: ,. _e__. D- S
BUILDING PERMIT NUMBER CROSS REFEREN•C " rw
1
• SIMa-trire of Applicant•
f
RECEIVED BY: (10/( _.
Tow. Clerk's Office
DATE: •�
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ptI lEgn T' 2,.irN OF 'OL;rHOLD NY..''„-`b� f, SEAL
IAN v7 1994 !!...L.--..,'
.4 _Yr,<ai;;r.'! } SAND r 157/2:''''-
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S.C. DEPT. + ;11:'' ''b,+` `,?”`{f,," AREA 2 SQ.FT. A5 SUPVEYED -.' • ' .IAN_ 18,1994 i # 't.4', 'r'7'
OF � "-r!.;;l„i„h,.1,,;_ti',+i••`,:, ,r 0`PIPE . ROD ICK VAN T L. C
HEALTH SERVICES :Si';°'• k`.', —_ FG.,\/...•,..., dr..7 w4TE¢ 8 ;+::,{: lr
I • LICENSED LAND / �2ao°�=s o `,
• SURVEYORS F LgND S�""
wott141pr, .4137, GREENPORT NEW YORK
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