HomeMy WebLinkAboutJacobson (2) r
OFFICE OF THE TOWN CLERK ��Fi JC C,
Town of Southold DSO •OG
Judith T. Terry, Town Clerk Zs
Town Hall, 53095 Main Road _ "...4;41-M
P. O. Box 1179 '44 ` ',
Southold, New York 11971 OH- ;� -
Telephone l „
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 10Z Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
PERMIT ISSUED TO:
NAME: Alan C. Jacobson
ADDRESS: 8050 Nassau Point Road
Cutchogue. New York 11935
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Alan C. and Priscilla K. Jacobson
OWNER MAILING ADDRESS: 8050 Nassau Point Road
Cutchogue. New York 11935
OWNER PROPERTY ADDRESS : 500 Crown Land Lane
Cutchogue. New York
TAX MAP NO. : Section 109 Block 2 Lot 12.8
CROSS STREET: Main Road
BUILDING PERMIT NUMBER CROSS REFERENCE: 156482
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Judith T. Terry l/
Southold Town Clerk
DATE: February 3. 1987 •
(TOWN SEAL)
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JUDITH T TERRY •ateiro.ii 0il - TELEPHONE
TOWN al.RI. (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
February 3, 1987
Alan C. Jacobson
8050 Nassau Point Road
Cutchogue, New York 11935
RE: 500 Crown Land Lane
Cutchogue, New York
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,
%owl, 4.:.104.aktiraft
Judith T. Terry
Southold Town Clerk
Enclosures (3)
JTT/Ijc
OFFICE OF THE TOWN CLERK M
Town of Southold
Judith T. Terry, Town Clerk Application..No. /� --
Town Hall, 53095 Main Road . - Construction (-
P. O. Box 1179
Alteration
Southold, New York 11971 _—__ _
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. /O
Fee $ /o
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DATE ,_54-NU y igf1 `" q�
APPLICANT NAME: ALM) � . _)/1-COI So3A.,)
APPLICANT ADDRESS: � cO /J�s i ) l. (a
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SEPTIC CESSPOOL ,/ •
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: J4cogi-J
OWNER OF PROPERTY:J414W C.. + patCLICA 1<„
OWNER MAILING ADDRESS: ?O O /U4-SS `Poi& f-o))-A
CQ A- 4Lo , A) ya 1/Q72.-
OWNER PROPERTY ADDRESS: CV) 0-J, L AAI t L.Ai i
ilkc91 u�� /0��_ l 6/72
TELEPHONE NUMBER OF CONTACT PERSON: s -d l ( 0
TAX MAP NO. : Section / 09 Block 2, Lot 12 + 8)
CROSS STREET: d A l(J 2C)41
BUILDING PERMIT NUMBER CROSS REFERENCE: 15-6 '18 Z
ab,,,4 ))
Signat •f Applicant
RECEIVED BY:CP
•Town erk's 0 Tice ,
DATE: � . _ _
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____^ I ` . SUFFOLK CO. HEALTH DEPT. APPROVAL
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_ I Cr'��� EXPIRES TWO Y ;MRo� FROM ATOF APPROVAL
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`�' " ` CONSTRUCTION, INC SYSTEMS FOR THIS RESIDENCE WILL
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