HomeMy WebLinkAboutNorth Ray Corp (4) ,,Ill,ilii/•---
JUDITH T.TERRYo Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
•
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER \=�� \s' Fax Fax(516)765-1823
RECORDS MANAGEMENT OFFICER � ����� 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. 1350 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : NORTH RAY CORP.
Address 1 : BOX 655
City St Zip SHIRLEY NY 11967
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. R10-05-0075
Name Of Owner NORTH RAY CORP.
Mailing Address 1 BOX 655
City St Zip SHIRLEY NY 11967
Property Address 1 HARVEST LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 120.00 block 3 lot 8.003
Cross Street ALDRICH LANE
Building Permit Number Cross Reference:
Issue Date: 7/12/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
JUDITH T. TERRY ; p® / Town Hall, 53095 Main Road
TOWN CLERK ® r ; P.O. Box 1179
� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �� -Fax (516) 765-1823
MARRIAGE OFFICER /3 Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER 1 .•
-
FREEDOM OF INFORMATION OFFICER :"�••�ii//r��l!
OFFICE OF THE TOWN CLERK _
TOWN OF SOUTHOLD �'t,�� f (I`' �If7 i� y
TO: Southold Town Building Department ` , JUN 2 8 1995 j!L_J'
FROM: Linda J. Cooper, Southold Town Clerk's Office -----s---- _r it Iii
;Lerma ---- li
aOyli SOUT
OF HOLD j
DATED: June 27, 1995 -_�-
Transmitted herewith is a copy of application No. 1401 for a Cesspool/
Septic Tank Construction Permit submitted by:
North Ray Corp. •
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 f/
DISAPPROVE
Comments: 7 cIC/4 "7", ,,3_4r,-30
RECEIVED
.: --71.70,-4 - ,, 7. ..e.ei<
JUL I 1 1995 Signaturj
Fon Clerk SWUM Date '`� 9-5
OFFICE OF THE TOWN CLERK ,.,,""""' ( / •
Town of Southold ,•�%''OC��FFDLxe'OG
Application No. / O /
Judith T. Terry, Town Clerk •• 44° '—
Town Hall 53095 Main Road
Construction
P. O. Box 1179 • .
Southold, New York 11971 �'•� Alteration
Telephone t. etc" •• $10.00 - Residential
(51,6) 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 o/ 77rT
APPLICANT NAME: ��� /20t./
APPLICANT ADDRESS: 67 �.�-S // 7 , 7
SEPTIC 'l CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION/cp,"...tt Ott-."-Geee-t
LOCATION MAP: ' Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Pre•-v—&_ _
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: /
TELEPHONE NUMBER OF CONTACT PERSON: 2
TAX MAP NO. : Section I� 0 Blo k 3 Lot F, ✓
CROSS STREET:
BUILDING PERMIT NUMBER -CROSS REFERENCE:
G
Signatureof Applicant
RECEIVED BY: L,c1/u /z-
-
own Clerk's Office
DATE: (Z- ( `Jr'
SUFFOLK CO.HEALTH
NO,DEPT,gppRrwVAL
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UNDER CDNST ' 01/NC i f 1 CVAG � A I
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I SINGLE FAMILY uYrELtiiG ONLY
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