HomeMy WebLinkAboutNorth Ray Corp (9) JUDITH T.TERRY ; 'LI® �fit Town Hall,53095 Main Road
TOWN CLERK _ kk P.O.Box 1179
`� >_ ,,., �� Southold,New York 11971
REGISTRARRIA E OFFICER \_ ®�STATISTICS 111 Fax(516)765-1823
RECORDS MANAGEMENT OFFICER <71 ` `' $.00. 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. 1332 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
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. #R10-95-0048
Name Of Owner NORTH RAY CORP.
Mailing Address 1 P. O. BOX 655
City St Zip SHIRLEY NY 11967
Property Address 1 OLD FIELD COURT
City St Zip MATTITUCK NY 11952
Tax Map No. section 120.00 block 3 lot 8.021
Cross Street FARMVEU ROAD
Building Permit Number Cross Reference:
Issue Date: 5/12/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/ 333--
JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = ties �, Fax (516) 765-1823
MARRIAGE OFFICER 4f' �®I�f Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER = ®1
FREEDOM OF INFORMATION OFFICER = ��i��to
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
IT VI
°agh� fi
TO: Southold Town Building Department • 0 1995 _�
FROM: Linda J. Cooper, Southold Town Clerk's Office -... f
BLDG. DEPT
DATED: May 10, 1995 TOWN OF SOUTHOLD
Transmitted herewith is a copy of application No. 1381 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 20
DISAPPROVE
Comments: Clad') ",,
07:40r a
Signat 411/
Date
.
•
OFFICE OF THE TOWN CLERK ,,•,"""
Town of Southold ,o'lecogf air",
Judith T. Terry, Town Clerk �' Ol/ : Application No. 15/
Town Hall, 53095 Main Road %�, R, / //
Construction I/
P. 0. Box 1179 t _;• • z `
Southold, New York 11971 Vs ";. . - yc Alteration
Telephone t I. a ,•�Q,r,''' - $10.00 - Residential
(516) 765-1801 _ �1 �, ' $25.00 -Non-Residential
. . I,,
TOWN OF SOUTHOLD -
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION ' ' ,
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE -5 /4 ` ln1
APPLICANT NAME: '-'2' "7:4274 L
APPLICANT ADDRESS: 081/2e; 4,ST- 77 //16,7
SEPTIC CESSPOOL ,, .,
DESCRIPTI OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: ' Must be attached hereto' before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION 0 ALTERATION:
OWNER OF PROPERTY: -71-41-4:4A. Ca
'OWNER MM LING ADDRESS: ' /3 17/ // 5
OWNER PROPERTY ADDRESS: a /,/ ( 71
ti,t,
/ �
vlror
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section dQ 0 Block 5 - Lot Q '• 2
CROSS STREET:
BUILDING' PERMIT NUMBER CROSS REFERENCE: d'U?'k -
Q44..,. ..._ .
- Signature of Applicant
RECEIVED BY: `-, �L ��
Town CI rk's Office
DATE: .._ //01 :S' '
Rrcl..,..,rel iIlv FOLK CO. HEALTH DEPT.APPROVAL
H S NO
vAc 25
VAC MAR''_1 1995 PLEASE NOTE
i r PCIC:::!------,�, _ , r I Minimum distanca between well
--- - -? -------- i _• R.%,“:::
_ cr _ SC DEPT. OF and cesspool is to be 150 feet.
U R.%,='f ✓ :i‹. HEALTH SERVICE-5—
STATEMENT OF INT
= CLDFIELD COURT v 50' �I;J - I , )E THE WATER SUPPLY AND SEWAGE DISPOSAL
� �
5 ' .��(`/ Eli '?C� SYSTEMS; FOR THIS RESIDENCE WILL
I N.7C 19 2S.0 — —_ —=
( CONFORM TO THE STANDARDS OF THE
j SUFFOLK CO DEPT OF HEALTH SERVICES
0 1 S0�=_XFt i C i("A,N 2FrT ''! OLE: `i Y (SI APPLICANT
I a J.
j O! �, ;O `; ' SUFFOLK COUNTY DEPT OF HEALTH
nz! d Y� P2GPSEPTIC ! SERVICES - FOR APPROVAL FOR
rn DATETRUCTION ONLYAQR 17 ,.
GA1 I H.S REF NO
pact, Ho 39 i\ SAP AP • •`. 1
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/ 0.0 SUFFOLK CO.Tls•3t97IAP0 9€" N-.$4
t 2 0 I DIST. SECT BLOCK PCL.
/� e>q { _LOCO 120 3 8.21
I 5C OWNERS ADDRESS
! --Co c T I '344 '.JM.FLOYD Pf1WY
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