HomeMy WebLinkAboutSimon (4) P 0e,, (if,/
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t Town Hall, 53095 Main Road
� ,i P.O. Box 1179
�
,�� Southold, New York 11971
JUDITH T.TERRY ®°� ��i•
FAX(516)765-1823
4' fe+i , TELEPHONE(516)7654801
TOWN CLERK
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. 582 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SIMON, ROBERT K.
Address 1 : 25 20TH STREET
City St Zip JERICHO NY 11753
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING AND SANITARY SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES.
Name Of Owner SIMON, ROBERT K.
Mailing Address 1 25 20TH STREET
City St Zip JERICHO NY 11753
Property Address 1 R.O.W. OFF WOOD LANE
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 6 lot 3.001
Cross Street INDIAN NECK LANE
Building Permit Number Cross Reference:
Issue Date: 2/14/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
ECEIVE==
1‘C r
4 , -,' K BLDG. DEPT.
vr;.* TOWN OF SOUTHOLD
1=3 r71
•� €� t , 3 f���G . own Hall,5309YMEirRoad
P.O. Box 1179
4,4 1:J �� I� Southold, New York 11971
JUDITH T.TERRY AP
TOWN CLERK �� TELEPHONE
(516) 765-1801
REGISTRAR OF 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: February 5, 1990
Transmitted herewith is a copy of application Noco596 for a Cesspool/
Septic Tank Construction Permit submitted by:
Robert K. Simon
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 1 �\
Comments: a•-, c ,se_6-,,,„1‘,\ LsOot.Qst e ."5/ttp..413-c1/4.9..
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T®stn t:Ierlt south- -
®1t$' Sign ture
Dated
•
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OFFICE OF THE TOWN CLERK c.0F
of Southold � Etre-
Town �
Judith T. Terry, Town Clerk F � Application No. -576
Town Hall, 53095 Main Road ; ;-_ h Construction
P. O. Box 1179 cn '`"` V-"y Alteration
Southold, New York 11971
Telephone IP; Residential
(516) 765-1801 I°
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE oZ/S"/9a
APPLICANT NAME: R28, -,,e 7- r. j a
APPLICANT ADDRESS: 2 - (2O`f` s /-
/CESSPOOL re /+ /Ve,,,) )o2Ac 1 /is 3
SEPTIC
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/VEKO C�n/572'Z. cT�yw semt tjF, 'nc �y+.rTi� --SCRIPTION
V 4-t i L r (.4)/ I.0 o Qi /2 zvt...) , i Aid S
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 0,,d1 ,,a S.A.1 O rt�
OWNER MAILING ADDRESS: ZS- - v?0 �- -,
Af // 7.s-3
OWNER PROPERTY ADDRESS: R O. !,J 0-F-F WOOD
D d T a AJ c ic .64-4)F -- Pe c aY✓i c.
TELEPHONE NUMBER OF CONTACT PERSON: 5'/6 4L33 - /2. e
TAX MAP NO. : Section cS(o Block Lot 3. 1
O.W. o-
CROSS STREET: CAJcoob L,4, oppos;.4 Bigzc,404-,j JP�SiDF�✓1-�
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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