HomeMy WebLinkAboutNorth Ray Corp (8) , Ly
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JUDITH T. TERRY •
Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS crs Southold, New York 11971
MARRIAGE OFFICER Fax 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. 1096 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : NORTH RAY CORP
Address 1 : P. O. 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. #R10-94-15
Name Of Owner NORTH RAY CORP.
Mailing Address 1 P. O. BOX 655
City St Zip SHIRLEY NY 11967
Property Address 1 OLD FILED COURT
City St Zip MATTITUCK NY 11952
Tax Map No. section 120.00 block 3 lot 8.020
Cross Street SOUND AVNEUE
Building Permit Number Cross Reference:
Issue Date: 3/10/94 Judith T. Terry
Southold Town Clerk
(TOWN SFAI 1
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �® d ,' Fax (516) 765-1823
MARRIAGE OFFICER
_ 42,42, Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER —_ A�
FREEDOM OF INFORMATION OFFICER777,
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OFFICE OF THE TOWN CLERKE 1, `:'° €._ '
TOWN OF SOUTHOLD
FEB 2 8 1994
L.)t Zi •. —t__�r.__ A
TO: Southold Town Building Department
TOM
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 28, 1994
Transmitted herewith is a copy of application No. 1133 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
DISAPPROVE
Comments: sG - 7 /'/p _9 V-/LS'
47b7
RECEIVE ,o;
a :Ale
MAR
Signature
M R 9 1994 9,
Dated
i'intkautd Tom taut
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OFFICE OF THE TOWN CLERK c,VFFUL1
Town of Southold
Town Clerk .. D� : Application No. `3
Judith T. Terry, t- A,g. � ,- , . ..0 /�
Town Hall, 53095 Main Road cc:P3 -SF - ��:y. Construction 4.-----
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P. O. Box 1179 ' ��
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Southold, New York 11971 O Alteration
Telephone
7OI ,_ ` NOS 0 • Residential !/
(516) 765-1801 "'
'Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTF lCT '
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE -a�
APPLICANT NAME: P /4d / A-17
s/ 41t7
APPLICANT ADDRESS: UJB ,�' ������c/, _ -
SEPTIC CESSPOOL V
DESCRIPTION .OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION, OR ALTERATION:
OWNER OF PROPERTY: 0 ( ea/ /eGr
OWNER MAILING ADDRESS: „g„go,U �� i(5)&2
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OWNER PROPERTY ADDRESS: .a , / / al141
At /
" TELEPHONE NUMBER OF CONTACT PERSON: e--) 5,4,,k,....2
TAX MAP NO. : Se tion i� 0 Block 5 Lot 2, 1 O
CROSS STREET: (2•(.c..l�Q,
BUILDING PERMIT NUMBER CROSS REFERENCE:
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' -;)/gnature of Applicant
RECEIVED BY: a.
Town lerk's Office
DATE: � � 7 V
• SUFFOLK CO.HEALTH DEPT.APPROVAL v3+'
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- STATEMENT OF i TENT
�,; G_D> 1ELD yti� y�/ THE WATER SUPPLY AND SEWAGE DISPOSAL
COD= EC`
j',, SYSTEMS FOR THIS RESIDENCE WILL
:70 19 �7<. :_125O - CONFORM TO THE STANDARDS OF- THE
41;,,' , ) - t ' SUFFOLK,*. DEPT/,OF EAL H SERVICES.
3''> yry� t 1 (S) / % NK
ti"` I I SokExoit' APP/CANT -35.6Z.5'1
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• C? ; +- vrFC 10 - SUFFOLK COUNTY DEPT. OF HEALTH
N > 0 SERVICES — FOR APPROVAL FOR
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CONSTRUCTION O
-- -� ,� , MAP ' OF _PRO Er.'T` ) DATE B 2 8 1994
'yq' I —---I MO- F. MO. r - 51.)EYED Frt�G H.S.REF.NO "2102Ovl�~
APPROVES. _rillir -
L-_-- -� - _ N 02TH 2AY CO2P , •.,•. -VI
SUFFOLK CO T• MA' DESIGNATION: I
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,,, y DIST. SECT =LOCK PCL.
is MAlam:7.ic . 120 3 820
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