HomeMy WebLinkAboutMichael •
JUDITH T.TERRY ` Town Hall, 53095 Main Road
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TOWN CLERK g P.O.Box 1179
O /�� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS O 1 Fax(516)765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER ,s`?� ®�1�/ Telephone(516)765-1800
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FREEDOM OF INFORMATION OFFICER of
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1291 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EAST ISLE CUSTOM BUILDERS INC. .
Address 1 : 278 JAMAICA AVENUE
City St Zip MEDFORD NY 11763 •
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. #R10-95-0014
Name Of Owner MICHAEL, ANDREAS AND MARIA
Mailing Address 1 C/O EAST ISLE
278 JAMAICA AVENUE
City St Zip MEDFORD NY 11763
Property Address 1 BERGEN AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 7 lot 3.000
Cross Street COX NECK ROAD
Building Permit Number Cross Reference:
Issue Date: 2/27/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY : r StTown Hall, 53095 Main Road
TOWN CLERK eP.O. Box 1179
VS ' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = gibg'r �'% Fax (516) 765-1823
MARRIAGE OFFICER ? ��® ` Ns:, �t Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER : % 1°..
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FREEDOM OF INFORMATION OFFICER -1
OFFICE OF THE TOWN CLERK a -'
TOWN OF SOUTHOLD i �� I s�°
U1111/r .
U FEB - 8 095 'j i
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office iBLDG.DEPT
TOWN OF SOUTHOLD
DATED: February 8, 1995
Transmitted herewith is a copy of application No. 1338 for a Cesspool/
Septic Tank Construction Permit submitted by:
East Isle Custom Builders, Inc. for Andreas & Maria Michael •
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.
k
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
a 9 �/'
Comments: yzevi--• 4 - jc7/ _ //® ��,-7o/l`'
Signature 1
,//:
Dated
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4
OFFICE `dF THE TOWN CLERK /33t
Town of Southold-, Application No.
Judith T. Terry, town Clerk Construction
Town Hall, 53095 Main Road
P. 0. Box 1179 Alteration
Southold, New York 11971 Residential _
Telephone
(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: [AST- _Ts 1-6 C ��G L _e ?aP-S l.c
APPLICANT ADDRESS: Z7 -44,4,,,,4 4,e,
fi/( pop_. -/-=.) yobe._
SEPTIC CESSPOOL '
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
c.G -)/(4-6'a,(-1.?"-----0 Lei o'/6
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : giUbJ i4S �- /1/1412,0_ Hi cH4
m � �S L�
OWNER MAILING ADDRESS: d AS( —
z7 --/./8 .6,/1 k(GbPe3in /0 //7
OWNER PROPERTY ADDRESS: -5/S �loG � •G>t •-----
Il)�c�l� 14A-T7/%etc_(_
TELEPHONE NUMBER OF CONTACT PERSON: 7 -&52- "' '
TAX MAP NO. : Section / /3 Block 7 Lot
CROSS STREET: �v ?0 ADOC*-- '... .
' BUILDING PERMIT NUMBER CROSS REFERENCE: '
cjr Gusto—
Signat'r- of Applicant
RECEIVED BY:
Town Jerk's Office
DATE: �/ ,Fcr
_ SUFFOLK CO.HEALTH DEPT.APPROVAL Y
•
_ IAP-CF PIZOPEr2.TY H.S. NO. `
_�-5U12-V EYE D. P01Z
DO-U_G GVP5-_- J ATT[2 D G " SINGLE FAOIILY MUM ONLY o
- �_,,;��N�-j- \ . �� - � -r . RES TREE YEARS FR01�DI::::
ATE OF AppROdfAL
�\ AT
_Mt�1�T(.Tf3CIL STATEMENT OF INTENT
II JJ 1OWNT SOUTHOLD N THE WATER SUPPLY AND SEWAGE DISPOSAL
f SYSTEMS FOR THIS RESIDENCE WILL
' CONFORM TO THE STANDARDS OF THE
3,4/' EEIZGEN AVENU0 - SUFFOL C . D OF EALTH SERVICES.
aD � (5)
3> 3.Z`J I t TCIy E M1� 100.fl �— 55g`. 3x}5C NECK.L�L7:, =-- APPL!CAN 7' 4I
-=9SNr, + WEA SUFFOLK COUNTY DEPT. OF 4IEALTH
d plumR SERVICES - FOR APPROV- L , OF
" > l CONSTRUCTION ONLY
Lv g 1 SD N DATE: 2139
f I / H.S RET.-1707.---2_7/0-1 S--D D
APPROVED:
...i ..._ / ,i
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Z g ® P i i .. SUFFOLK CO_TAX MAP DESIGNATION:
71-
l� DIST. SECT BLOCK PCL.
tt 1 N � I« Ila
;if 8 W (U OWNERS ADDRESS:
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