HomeMy WebLinkAboutSeifert (2) 4 'I01\0StFFO�,�oG-
JUDITH T.TERRY ��� t<N Town Hall, 53095 Main Road
TOWN CLERK ; y _ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O
$ Southold, New York 11971'
MARRIAGE OFFICER y* ��'01 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER l * �►� 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. 1420 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : FRED SEIFERT
Address 1 : 725-B6 GREENBRIAR DRIVE
City St Zip BOHEMIA NY 11716
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. #R10-95-0125
Name Of Owner SEIFERT, FRED AND CHERYL
Mailing Address 1 725-B6 GREENBRIAR DRIVE
City St Zip BOHEMIA NY 11716
Property Address 1 285 MEADOW BEACH LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 17 lot 17.024
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 11/21/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
7 (17,)-D
JUDITH T.TERRY � :x e Town Hall, 53095 Main Road
9 '1�,L
TOWN CLERK k ;, P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 0 Fax(516)765-1823
MARRIAGE OFFICER L �s2,
RECORDS MANAGEMENT OFFICER `�s' °�01° Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER "
OFFICE OF THE TOWN CLERK ;
TOWN OF SOUTHOLD f//Jai
TO: Southold Town Building Department � 7799
4.,s
r
FROM: Linda J. Cooper, Southold Town Clerk's Office
Of�
DATED: November 16, 1995
Transmitted herewith is a copy of application No. 1475 for a Cesspool/
Septic Tank Construction Permit submitted by:
Fred Seifert
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 L./'--
DISAPPROVE
Comments: l` i.l�y,7 cSWZ)
S'.nature `"/
Dated
OFFICE OF THE'TOWN CLERK ,•,""" •
Town'of Southold ..1'•'CAVOL,��- ; Q ?/
Town Clerk � Ol/ Application No.
Judith T. Terry,
Town Hall, 53095 Main Road '' ' '
Construction
P. 0. Box 1179 _'` '�
• v �' ^' • Alteration
Southold, New York 11971 ctl Y :: •.`
Telephone %=y�,e40 ���• $10.00 - Residential
(516) 765-1801 = 1 ' $25.00 - Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
•
DATE 1A f l(0 ( q5
APPLICANT NAME: Eike') SE( FE2(—
APPLICANT ADDRESS: 1 2-5 3 (4 G a-6GNI 1L4 7 P
• i3 Lfi�'�n r N l("I I(9
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
NEIL cow)S-TU un o o-F• RES (O61,-)T1 & w(E
LOCATION MAP: ' Must be attached hereto before permit may be issued. _
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: f v Et> 6.. C(+F A-/ I L, 5E(FE KT
OWNER MAILING ADDRESS: 1'x-5 - ! t' 6 2EE N313 Tt "to__ c�
15 o n--, 1 zF i O l 1 -11ig
OWNER PROPERTY ADDRESS: ►4EI\hdv r LAEQE
ATn i-u C(L. 11
TELEPHONE NUMBER OF CONTACT PERSON: 21-I1-1 —54-0 to I
_TAX •MAP NO. : , Section 1(5 Block 11 - Lot ' ' 11. 2.9
CROSS STREET: NEW SL( old< 'kve )0e
BUILDING PERMIT NUMBER CROSS REFERENCE:
//6 S
Signature of Applicant
RECEIVED BY: LA.A.44____ 7
To n Clerk s Office
DATE: �� ��
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