HomeMy WebLinkAboutShannon JUDITH T. TERRY R Town Hall, 53095 Main Road
TOWN CLERK F° ;-; " P.O. Box 1179
45) `1Y` . Southold, New York 11971
REGISTRAR OF VITAL STATISTICS j` Fax¢. 44% Fax (516) 765-1823
MARRIAGE OFFICER _. Opf �® et, Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER �=� ®d .,,
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. 1244 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ANN SHANNON
Address 1 : 2775 MARRATOOKA ROAD
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner SHANNON, ANN
Mailing Address 1 2775 MARRATOOKA ROAD
City St Zip MATTTITUCK NY 11952
Property Address 1 2775 MARRATOOKA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 2 lot 26.000
Cross Street CENTER STREET
Building Permit Number Cross Reference:
Issue Date: 11/15/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
— J a2,V111
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS • _
® Fax Fax (516) 765-1823
MARRIAGE OFFICER _ 1� %®I�� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ®1 �o
FREEDOM OF INFORMATION OFFICER ...",.....”,10°1�l
OFFICE OF THE TOWN CLERK // ifl
TOWN OF SOUTHOLD TO: Southold Town Building Departmentfi 1 FM
FROM: Linda Cooper, Southold Town Clerk's Office 11 NOV
DATED: November 9, 1994t 1' .._ 1
TOWP D DEPS =-; A i
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Transmitted herewith is a copy of application No. A1290 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Raymond Nine for Ann Shannon
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following commendation:
APPROVE - 10. LAVATION 9NSPECTII
DISAPPROVE - E� ��
COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Signatur- /
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OFFICE OF THE TOWN CLERK ,,,,"""''--.-
Town of Southold
Judith, T. Terry, Town Clerk / Application No /496'Hall, 53095 Main Road •1= Construction
P. 0. Box 1179 74,
Southold, New York 11971 •cats yc Alteration
Telephone =��,jj,�� ��� �', $10.00 - Residential �—
(516) 765-1801 : 1 * ,, " $25.00 -Non-Residential
,,.,,,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT -
SEPTIC TANK or CESSPOOL L -
Permit No. r,
Fee $ - - --
DATE /// / yfr/
APPLICANT NAME: , y✓/'Y 5/f /9 )v N4 N
APPLICANT ADDRESS: 27'/S yhichr / iTGGR-`f
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /V5W
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /��✓NS 1� fi`��v� N
OWNER MAILING ADDRESS: 2,7y1' TUG•47, 15' 69
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 9 ?-g-6-2"
TAX MAP NO. : Section 1,3 Block Lot •2,‘
CROSS STREET: G FI✓7 ' S 7
BUILDING PERMIT NUMBER CROSS REFERENCE:
o2214
/nature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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