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JUDITH T. TERRY .v �� ,, Town Hall, 53095 Main Road
TOWN CLERK ® t ` {` P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS •1" Fax (516) 765-1823
MARRIAGE OFFICER •��}� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER �
FREEDOM OF INFORMATION OFFICER 162-‘,,2161:90:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1182 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PATTERSON INDUSTRIES
Address 1 : 11 KALMIA STREET
City St Zip EAST NORTHPORT NY 11721
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. #100-01-42
Name Of Owner NALBANTIAN, EDWARD AND CHARLES
Mailing Address 1 C/O FRED SNYDER, P.E.
11 KALMIA STREET
City St Zip EAST NORTHPORT NY 11721
Property Address 1 HARBORVIEW AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 100.00 block 1 lot 42.000
Cross Street REEVE ROAD
Building Permit Number Cross Reference:
Issue Date: 8/12/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY % Town Hall, 53095 Main Road
TOWN CLERK ® rP.O. Box 1179
ch *. $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = "C". '' Fax (516) 765-1823
MARRIAGE OFFICER ' * • ,1' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ®1
FREEDOM OF INFORMATION OFFICER .+���••iiiti°'/I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD D 6 111 1
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TO: Southold Town Building Department
Al IG 2 1994
TOWN OF SOuTH
FROM: Linda J. Cooper, Southold Town Clerk's Office BLDG DEpT
DATED: August 2, 1994
OL0
Transmitted herewith is a copy of application No. 1226 for a Cesspool/
Septic Tank Construction Permit submitted by:
Paterson Industries for Edward and Charles Nalbantian .
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.
4w
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
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Comments: .✓z/'� ./L,2.07,2Je%.,.o , �(✓Dfz
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Signature _
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OFFICE OF THE TOWN CLERK c$FWA
Town of Southold fr� rh ‘10Judith T. Terry, Town Clerk Application No.
Town Hall, 53095 Main Road ,:, __41:-&' .};i7' Construction
Ov
P. 0. Box 1179 ~
Southold, New York 11971
Alteration
Telephone 10 ��O �� 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./ th6
Fee $ /(), �
DATE 6f oC9 1°11°11-A
APPLICANT NAME: ()Fr-7F 25'89 ) 57g WtS
APPLICANT ADDRESS: 1K4- S l(o� (--t v-' j
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/dew' '1��' ? VV]
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: R_OPKO 5 C e3RH S 0191131i-A1M910
OWNER MAILING ADDRESS: 1 PQ( I? ;j,1)Y e f/5
!/ / 911 2i4 sr- 6,4/07-7-14by //75/
OWNER PROPERTY ADDRESS: /!�� G, .1//lez /ij 'fL,
TELEPHONE NUMBER OF CONTACT PERSON: 52/ 5`/ "i(36--2C)
TAX MAP NO. : Section /O ® Block 0 / Lot
CROSS STREET: gee-v-e_ c ac
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signatur- o'i,p.,/cant
RECEIVED BY:
erk's Office
DATE: AUG 2 1994
lawn Clerk Southold
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