HomeMy WebLinkAboutMarquardt JUDITH T. TERRY �� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS rqr6 Southold, New York 11971
MARRIAGE OFFICER .;�! Fax (516) 765-1823
;® �! Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 909 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ' DAVID T. MARQUARDT
Address 1 : 525-118 RIVERLEIGH AVENUE
City St Zip RIVERHEAD NY 11901
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH SANITARY SYSTEM.
APPROVED AS SUBMITTED AND APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF
HEALTH SERVICES ON 11/25/91 .
Name Of Owner MARQUARDT, DAVID &
Mailing Address 1 WHALEN, JOHN
525-118 RIVERLEIGH AVENUE
City St Zip RIVERHEAD NY 11901
Property Address 1 LEGION ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 141 .00 block 4 lot 15.000
Cross Street PACIFIC STREET
Building Permit Number Cross Reference:
Issue Date: 9/18/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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•JUDITH T. TERRY j F,, U ; Townjia11tt VSti3095 Main Road
TOWN CLERK . 'nil 4
l: O. :e e'T. P.O. pox 1179
REGISTRAR OF VITAL STATISTICS ' ' TOWN OF SOUTgalthlisL,Nbw York 11971
MARRIAGE OFFICER r ®� ,•1� Fax (516) 765-1823
___ o ,ss�z, �`;: i! Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 8, 1992
Transmitted herewith is a copy of application No. 933 for a Cesspool/
Septic Tank Construction Permit submitted by:
David I Marquardt .
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.
- z -
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations: ,
APPROVE ItC
DISAPPROVE
Comments: n c� C.' . )143z
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Signature
9111\c ax .
Dated
OFFICE OF THE TOWN CLERK c2,1F0/,-
• Town of Southold 0,_K �Oy
Judith T. Terry, Town Clerk Application No. i
Town Hall, 53095Main Road o :.ice: /
•
r Construction V
P. 0. Box 1179 v�
Southold, New York 11971 Alteration
Telephone / ,60W
.601-t Residential 1/
(516) 765-1F301 n�
Non-Residential
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No.
Fee .$
DATE J
APPLICANT NAME: i 2.0/#-•//0 T �,�//eQ u4te 0
APPLICANT ADDRESS: 5A �" —//c3 /,�/cJ y
/ //Pof
SEPTIC CESSPOOL -
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Aj 4: (J)
LOCATION MAP: Must be attached hereto before permit may be issued. .
LOCATION OF PROPOSED CONS UCTION OR ALTERATION:
OWNER OF PROPERTY: pjl j ,i-7/9y c2 (r- a,
OWNER MAILING ADDRESS: J.' /L t C /2 ic'
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT, PERSON: 3 C - J 48 6 oZ
TAX MAP NO. : Section / 1/ / Block e Lot o / S-
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:.
Sign ur of pplicant
RECEIVED BY tQGuli
Town (Perk' Office
DATE: � ' g meq ' • .
f , SUFFOLK CO.HEALTH DEPT APPROVAL*,
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I !t is the >v�llcani s rl?s��r.-
:,\ - '�U12.vE.N(c.=Cr 1-':-Or; maintain cV q^uatfl sanity:rye ctcis anc9
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1� Paps,.WELL r-r •... PRIOR TO �',11��_�- VY l�_1,: 1 V
SUFFOLK CO. DEPT OF HEALTH SERVICES
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