HomeMy WebLinkAboutSmith (14) JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® T ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ,� Southold, New York 11971
MARRIAGE OFFICER _ ,1 Fax (516) 765-1823
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(516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 985 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JAMES B. SMITH
Address 1 : 495 WEST SHORE DRIVE
City St Zip SOUTHOLD ,NY 11971
Descripton of Proposed Construction or. Alteration
INSTALL ADDITIONAL CESSPOOL SYSTEM TO EXISTING DWELLING.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED. CALL
765-1802 FOR INSPECTION.
Name Of Owner SMITH, JAMES B.
Mailing Address 1 495 WEST SHORE DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 495 WEST SHORE DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 80.00 block 2 lot 2.000
Cross Street OAK DRIVE
Building Permit Number Cross Reference:
Issue Date: 4/27/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK h+ P.O Box 1179
REGISTRAR OF VITAL STATISTICS N( .�` Southold, New York 11971
MARRIAGE OFFICER �® '��. Fax (516) 765-1823
Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: April 27, 1993
•
Transmitted herewith is a copy of application No. A1016 for an •
ALTERATION PERMIT for a cesspool or septic system submitted by
James B. Smith
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.
CSC -G"
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - y
DISAPPROVE -
COMMENTS: cu.,. a.+,..S.•;...c..1:4•U Gn'10. al' ��C�.f-QJ�.
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tom• qk, Signature
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Date
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OFFICE OF THE TOWN CLERK ,,,,,,,,,,,,
Town
Town of Southold .'''l�\\VULk1
Judith T. Terry, Town Clerk ,'s�®,, < ®�� Application No. /Q/6
Town Hall, 53095 Main Road ;� E. - Construction r
P. O. Box 1179 =v rn
Southold, New York 11971 tt� �� Alteration
Telephone t. 40
` - `��® •� $10.00 - Residential �-
(516) 765-1801 14g s'
$25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee ,$
•
DATE 9A 7 2,
APPLICANT NAME:• 5, / y
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APPLICANT ADDRESS: 4' 75
S O LL- 2-Wo L /J 1 Wil/ /. 1/27/
SEPTIC t./C.tSSPOOL '—
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION c,,9Lz.
/ a L y S'7,6- /7 e>vv /i �/17-��i N 6 N — ,P/52- 7—
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ��j7Gs' /
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: , h//7 O 7-cc 4,e
5OccrW L
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : SectionJ42(5JO Block Qt,200 Lot G Q ,J/ DO d
CROSS STREET: O X pieta-
BUILDING
ietv'BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant -
RECEIVED BY: Co_
Town erk's Office
DATE: 6/m2.-2
prepared In accordance with Um minimum The water supply and sewage dls?osol .
standards for Illle surveys as established systems for this residence will cm.orm
Nell byIke L.I.A.L.S. and approved and adopted to the standards of The Suffolk Cbunly •
hoc• fr such use by The Yew York Stale Land Department of Health Services.
Title Association. weft
l�, The locations of wells and cesspools shown hereon are from field i, .nKnnwn
•Yk'S� observations 4 d or from dole obtained from others. cP1
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