HomeMy WebLinkAboutJacoby P
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Town Hall, 53095 Main Road
®� 44 P.O. Box 1179
N:V4® �� '
s Southold, New York 11971
JUDITH T.TERRY :�,,, i�%' �I FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 608 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : DANIEL JACOBY
Address 1 : 383 ANDREWS ROAD
City St Zip EAST WILLISTON NY 11596
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED. CALL SOUTHOLD
TOWN BUILDING DEPARTMENT (516-765-1802) FOR AN APPOINTMENT.
Name Of Owner JACOBY, DANIEL
Mailing Address 1 383 ANDREWS ROAD
City St Zip EAST WILLISTON NY 11596
Property Address 1 3055 KIRKUP LANE
City St Zip LAUREL NY 11948
Tax Map No. section 125.00 block 1 lot 5.001
Cross Street SOUND AVENUE
Building Permit Number Cross Reference:
Issue Date: 5/07/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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t� 4.7ra',, ; �. , �.� Town Hall, 53095 Main Road
��� ��- 1 P.O. Box 1179�� '�.411 \�..... Southold, New York 11971
JUDITH T.TERRY AP.,.x,0,00°- TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS �� ��.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD 1 s --- Y
41990 l
To: Southold Town Code Enforcement Officer, al� IA� - 2 __,
From: Linda Cooper, Southold Town Clerk's Office i� '`� ;, ': .'', '°
Dated: May 2, 1990 JN - '
Transmitted herewith is a copy of application No. 623 for a Cesspool/
Septic Tank Construction Permit submitted by:
INLAND HOMES for DANIEL JACOBY
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: al t .� i�p �� Q,,,,,� �
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Signature
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OFFICE OF THE TOWN CLERK c0FQCA'`+O'
Town of Southold Application No. L., )5
Judith T. Terry, Town Clerk ter
Town Hall, 53095 Main Road ` c=1 �Y `t Construction
P. O. Box 1179 ,,V � Alteration
"�'` '
Southold, New York 11971 •��-•,
Telephone 79/ iNt Residential
(516) 765-1801 • Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ / b, 1)-6 — --
_die I mac- -°1411DATE J Sae / •
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APPLICANT NAME:
APPLICANT ADDRESS: ''`' • �'� - � )A.
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto befor permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: � • /K ,‘-'76 ,
;
TELEPHONE NUMBER OF CONTACT PERSON : cy
TAX MAP NO. : Section 1 Block ® 7 Lot
CROSS STREET: 9
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Signature of Applica n
•
RECEIVED BY: AA A,krep-m � Lq k(
• Town Clerks Office
DATE: k4V3pl�c {0
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. THE WATER SUPPLY AND SEWAGE DISPOSAL FACILITIES
4: .' - -S , F FOR ALL LOTS IN THIS DEVELOPMENTCOMPLY WITH THE
STANDARDS AND REQUIREMENTS OF THE SUFFOLK COUNTY
y' DEPARTMENT OF HEALTH. °'
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%�h P;! SUFFOU(,COUNTY DEPARTMENT OF HEALTH
90o a< ,; SERVICE:
sep�� a!t FOR APPROVAL OF CONSTRUCTION OF , ,
' •.- - Single Family Residence Only .
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TYPICAL SEWAGE DISPOSAL SYSTEM APPROVED `
EXPIRES TWO YEARS :OM I,TE OF APPROVAL ;