HomeMy WebLinkAboutPelletier ° Town Hall, 53095 Main Road
P.O. Box 1179
-__ ,ss22, ��® �► Southold, New York 11971
JUDITH T.TERRY -.®� `2s yi° FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 527 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PELLETIER, RENEE
Address 1 : 5 STRAIGHT LANE
City St Zip LEVITTOWN NY 11756
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES 6/5/89
Name Of Owner PELLETIER, RENEE
Mailing Address 1 5 STRAIGHT LANE
City St Zip LEVITTOWN NY 11756
Property Address 1 SOUNDVIEW AVENUE
City St Zip PECONIC NY 11958
Tax Map No. section 67.00 block 6 lot 4.000
Cross Street FASBENDER AVENUE
Building Permit Number Cross Reference:
Issue Date: 8/09/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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TOWN OF OUTHOLD •-.”:;: =P!V`4'-"_ ' " ' Town Hall,
.._.._ _...._. W._ .,,..,�.,9 ;� _ 53095 Main Road
� 9 �" �- P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY • • 'te TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR 01 VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: August 4, 1989
Transmitted herewith is a copy of application No. 540 for 'a Cesspool/
Septic Tank Construction Permit submitted by:
Renee Pelletier
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 X
DISAPPROVE
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AUG 04'x19 40G 0/1g89 Signature
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Town CierE 4:11iii..4 at!e4 ,� ft�l� Dated
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OFFICE OF--THE TOWN CLERK Cjq, Oi,(`,'
Town of Southold 0\�f�r,''.:i.'
': ; (7- SVC)
Judith T. Terry, Town Clerk ` ' ='__ '` ' Application No.
Town Hall, 53095 Main Road o I• - 0,-. .1.14. ....---• )4Construction
P. O. Box 1179 �'uY •
Southold, New York 11971 O,';. Alteration
'`j 3:1‘ j1�� Residential i.�
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
F/101 7 01
/ ,e_47 401--r
APPLICANT NAME: ff P �
APPLICANT AD DR ES ' Cc7 r j L ,e_:_P Ut c-
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SEPTIC I/ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION Al P (-J. c.t)2 ( r
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONS UCTION OR AL ER T)ON:
OWNER OF PROPERTY: Q 4 f ->° A/çier/
OWNER MAILING ADDRESS: c -cci-r'c. ,/1/ /
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OWNER
—OWNER PROPERTY ADDRESS: cc(Vy(0 (/'i (.3 cl g—
P-€ c CrY\-1 c /01/ r
TELEPHONE NUMBER OF CONTACT PERSON : 7� r _
TAX MAP NO. : Section-N7 Block C Lot .
CROSS STREET:1 d��j~2',1C/.P r
BUILDING PERMIT NUMBER CROSS REFERENCE:.
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.41 "ignaiure of Applic..;�
RECEIVED BY :
Town Clerk's Office
DATE:
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