HomeMy WebLinkAboutSeymour _ .J
4!1'
` Town Hall, 53095 Main Road
P.O. Box 1179
r I. Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 549 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SEYMOUR, RICHARD A.
Address 1 : 957 HAWKINS AVENUE
City St Zip LAKE GROVE NY 11755
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 8/89.
Name Of Owner SEYMOUR, RICHARD A.
Mailing Address 1 957 HAWKINS AVENUE
City St Zip LAKE GROVE NY 11755
Property Address 1 425 SECOND AVENUE
City St Zip PECONIC NY 11958
Tax Map No. section 67.00 block 2 lot 14.000
Cross Street MILL LANE
Building Permit Number Cross Reference:
Issue Date: 9/14/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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i r��,. �.� 4 Town Hall, 53095 Main Road
' ; TOWN OF SOUTHOLD tj„, 'u r ' �1 P.O. Box 1179
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= �.� k� int Southold, New York 11971
JUDITH T.TERRY / TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: September 12, 1989
Transmitted herewith is a copy of application No. 563 for a Cesspool/
Septic Tank Construction Permit submitted by:
Richard A. , Seymour
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 O(
DISAPPROVE
Comments: q� 1 ,rte c cuj fitpk,,,�
% -c,.‘A. \ . V e\
NC a6...k.CD -s--2-ct-L4Q
Signature
GA\A16\
Dated
OFFICE OF THE TOWN CLERK cjU FUC;{j,�
Town of Southold '4y&� Application No.J�
Judith T. Terry, Town Clerk "�r- 'z�`
Town Hall, 53095 Main Road a ;' �� ' Construction
P. O. Box 1179 Ovr, _t
Southold, New York 11971 4 Alteration
Telephone
�1 .11 �® 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.
Fee $
DATE
APPLICANT NAME: fict44
APPLICANT ADDRESS: j
SEPTIC )G CESSPOOL
DESCRI (ITION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: �- �c�v
OWNER MAILING ADDRESS: 7.57 /-4`.2/4Ave
Ge/h- ' 7 Si--
OWNER PROPERTY ADDRESS: 5'L SS,c G` dVY If�e LvL I`C
TELEPHONE NUMBER OF CONTACT PERSON :
TAX MAP NO. : Section - Block 7 -'✓1KL=ot-
CROSS STREET: A/7/
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Signature-.of-Applicant
RECEIVED BY:
REelgewn Clerk's Office
DATE:
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( DWELLING ) `_SCP,
( DWELLING ) ( DWELLING )
CP. LOCATION UNKNOWN) • CR LOC .1
UNKNOWN )
,
WELL
SUBDIVISION — in"PECONIC SHORES" IN BASEMENT
LOT I9 SUFF. CO. FILE NO. 117
o LOT 21 I
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