HomeMy WebLinkAboutSambach (2) JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® .' P.O. Box 1179
tr) Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ��� Fax (516) 765-1823
MARRIAGE OFFICER ® i
RECORDS MANAGEMENT OFFICER ���•. Telephone (516) 765-1801
FREEDOM OF INFORMATION OFFICER i. l
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1132 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL SERVICE
Address 1: 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES.
ATTENTION: EXCAVATION INSPECTION REQUIRED]]]]
Name Of Owner SAMBACH, WARREN
Mailing Address 1 255 DOGWOOD LANE EXT.
City St Zip EAST MARION NY 11939
Property Address 1 255 DOGWOOD LANE EXT.
City St Zip EAST MARION NY 11939
Tax Map No. section 37.00 block 1 lot 9.000
Cross Street OLD ORCHARD ROAD
Building Permit Number Cross Reference:
Issue Date: 5/24/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL_1
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JUDITH T. TERRY 14. Town Hall, 53095 Main Road
TOWN CLERK : ® ; * P.O. Box 1179
tri ;� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER ® ��
RECORDS MANAGEMENT OFFICER _ ®1 � i Telephone (516) 765-1801
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK 0 EL VE rr+ '
TOWN OF SOUTHOLD
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TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office ("
DATED: May 10, 1994
Transmitted herewith is a copy of application No. 1171 for a Cesspool/
Septic Tank Construction Permit submitted by:
- Morris Cesspool Servic for Warren Sambach
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
EXCAVATION
DISAPPROVE RE,-I
Comments: /� ��
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imr,/4,1 ,,e,g4,
Signatur:
(-7/2/9/V
Dated
fIlititis •
OFFICE OF THE TOWN CLERK ,,,'""""'
Town of Southold ,i'l 0/./re;
Judith 'T. Terry, Town Clerk 1,��ts% . c/, ' Application No.'�t�7
Town Hall, -53095 Main Road :G; Construction
P. O. Box 1179 ; v r=i•+ , R -
Southold, New York 11971 ,ctl ��� Alteration
Telephone ,`'O,y� �Q���' $10.00 - Residential
(516) 765-1801 _ 6l *�, s' $25.00 -Non-Residential
' -. .aII'
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE /27 4 / 7
y
APPLICANT NAME: "12/2f5 e65,4 �p�rrr..P�
APPLICANT ADDRESS: 6.27 , '.., P"
SEPTIC CESSPOOL Z-••' /
DESCRIPTIONO PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 4i/wk AI SI/IP/hid
OWNER MAILING ADDRESS: 2.r'y'4��.? 4 7--
Acesr ?et'
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OWNER PROPERTY ADDRESS:
. TELEPHONE •NUMBER OF CONTACT PERSON: 5 'X •-3 . _
TAX MAP NO. : Section _ 7 Block / Lot 9
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
drai
- Signature of Applicant
RECEIVED BY: A fK .
Town Clerk's Office ' •
DATE: ---7/d/ / •
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