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HomeMy WebLinkAboutRubin (2) JUDITH T.TERRY ` ® Town Hall,53095 Main Road TOWN CLERKcry P.O.Box 1179 REGISTRAR OF VITAL STATISTICS VO O 0 Southold,New York 11971 Fax(516)765-1823 MARRIAGE OFFICER = RECORDS MANAGEMENT OFFICER ED j® �� 1�� 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. 1297 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : LAWRENCE A. RUBIN Address 1 : 6 GEHRIG STREET City St Zip COMMACK NY 11725 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. #R10-95-0027 Name Of Owner RUBIN, LAWRENCE A. Mailing Address 1 6 GEHRIG STREET City St Zip COMMACK NY 11725 Property Address 1 JOCKEY CREEK DRIVE City St Zip SOUTHOLD NY 11971 Tax Map No. section 70.00 block 2 lot 26.002 Cross Street OAKLAWN AVENUE Building Permit Number Cross Reference: Issue Date: 3/03/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) /D2y7 GI COM/re JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 tr3 ; Southold, New York 11971 REGISTRAR OF VITAL STATISTICS �® Fax (516) 765-1823 MARRIAGE OFFICER a,' �� Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER --- 'I OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD ;; U1Ef£ TO: Southold Town Building Department FEB Z 8 199 FROM: Linda J. Cooper, Southold Town Clerk's Office � �` �, �;-�� j ilfil71 DATED: z,� �y �L.� s February 28, 1995 ;�aLrl Transmitted herewith is a copy of application No. 1344 for a Cesspool/ Septic Tank Construction Permit submitted by: Lawrence A. Rubin • 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: i 0.51�,/ ie. ,D -9r_ O 7 Signature Dated OFFICE OF THE TOWN CLERK ,,. ,""""' • Town of Southold _ �0 Judith T. Terry, Town Clerk ��' �� Gam_ Application No. /3 ? Town Hall, 53095 Main Road %-4 • Construction c� P. O. Box 1179 =R' = ^' Alteration Southold, New York 11971 cr) Telephone ,y® .� i� $10.00 - Residential (516) 765-1801 °1 ! r, ' $25.00 - Non-Residential • �, - - ,,, TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT • APPLICAT ION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE 2./2 /q APPLICANT NAME: La. Wim«-- 6\ n APPLICANT ADDRESS: C a WI Y 72:C SEPTIC CESSPOOL V DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION N a S l ki&Le (_A-M/c.`I P W t---1-(--/(k/(" LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: Law-v,v7 u A •12ubI v7 OWNER MAILING ADDRESS: 6 gk-ce-)- Corn rvlu72- OWNER PROPERTY ADDRESS: .q--dCK- yC_ R-e-e-k- r2 u--/- /1 L9 TELEPHONE NUMBER OF CONTACT PERSON: (Si ) Lig 3- Lf X03 TAX MAP NO. : Section 0 -70 Block Z. Lot 2�. CROSS STREET:____,5��-rt".4cH_C� —�c- Octk\c.w J .- BUILDING PERMIT NUMBER CROSS REFERENCE: ( Signature of Applicant RECEIVED BY: ' T wn Clerk's Office DATE: 6 4,r7- IRlCIZlI!IETflJ • LfCO.HEi4:7 N•DEPT-r • H.S''•'NO. JAM Y 1495 " -'` `' ti t , : = '1� U ifV �� oma: . °�9- I- - -�_-_ - - J % A� STATL. EMENY-OF(NTEN'r.,. -•' u1VfOT*/ THE WATER SUPPI.Y,AND SEWi�f3tE'©ISPOSAL C/-/bpL t�!$T, ` ' : \ ' I ,Cou€t`7'y', ( ! SYSTEMS 'FOR THIS RESIDENCE_ WILL CONFORM TO THE 'STANDARDS OF' THE SUFFOLK CO. DEPT OF,.HEALTH SERVICES. . \ --q_ �V �� ? `3� e"&.�iS�'r"s1$� JQ`l(`l� (Si \ ~�� ���XCY APPLICANT fc%rte AL e f liy � --`.7Ga`3a.% c-' 4 ° �7L. $c!x/a: SO'z•1" ' ----------,::__.-..c` 707 ,. % �I- �', -h , '`Ar.6ac= 31,-5a6 - SUFFOLK COUNTY -DEPT. 'OF -HEALTH ., \ y ;•_�� / ,moi+ %' !� •• ' \ ei =.•tiiotturrief-* SERV-ICES - FOR APPROVAL POR } ` / �, CONSTRUCTION ONLY _! •s DATE. ,FEB 2 19 o. isA\ _ -; 1 - O. _ ~ C_` H S. '( F O.. /r�-.� - oQc� �, z y N • \x ' \ • 1 \ .'1 ` i sJ a { �O ‘ • p SUFFOLK CO.TAX MAP DESIGNATION:- eess�4+e1 I 'S • �i ,'' '7 L DIST SECT. BLOCK • •PCL.- i -- ' "Q 5.8232 • , . AIItvt 5UZtxkxr.\ ' -"\ %\,- so.o__,- .' s�, � ;I . rano O7o 2 Z4�.2. °t� ,. • , l4 ��, �� . ` �i 1 OWNER'S ADDRESS. ! _r , ,,� ,1-._,,',/t,- ,\ 7, �\ / tS 20� L6 �`'` (o s tlNid S . ~9j `! t '��5� '� SfMore s�'� \\� * 'e. � , N c`.DtflttlatGGt= 1 Il3J l lJ \ 493- Sr?03 r \ s ---' ai�ac ''. DEED. L. 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