HomeMy WebLinkAboutStaples (2) JUDITH T. TERRY ` O Town Hall, 53095 Main Road
TOWN CLERK • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS on
r� Southold, New York 11971
MARRIAGE OFFICER `�'�`� Fax (516) 765 1823
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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. 698 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : HALSEY A. STAPLES
Address 1 : 29 MIDDLETON ROAD
City St Zip GREENPORT NY 11944
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.
Name Of Owner STAPLES, HALSEY A.
Mailing Address 1 29 MIDDLETON ROAD
City St Zip GREENPORT NY 11944
Property Address 1 36 MIDDLETON ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 41 .00 block 2 lot 12.001
Cross Street WASHINGTON AVENUE
Building Permit Number Cross Reference:
Issue Date: 4/15/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY y TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: March 29, 1991
Transmitted herewith is a copy of application No. 7.17 for a Cesspool/
Septic Tank Construction Permit submitted by:
Halsey A. Staples
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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OF.5 ICE "OF THE TOWN CLERK 4., F�(,�(
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Judith T. Terry, Town Clerk _ � �, ,; Application No. z
Town Hall, 53095 Main Road
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cn c� r�' j� �' Construction
P. O Box 1179
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Southold, New York 11971 Ot ' Alteration
Telephone 3 [ Residential
(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 MARCH 28, 1991
APPLICANT NAME: HALSEY A. STAPLES
APPLICANT ADDRESS: 29 MIDDLETON ROAD, GREENPORT, N.Y. 11944
SEPTIC X CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
CONSTRUCTION OF NEW SEPTIC SYSTEM
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: HALSEY A. STAPLES
OWNER MAILING ADDRESS: 29 Middleton Rd.
Greenport, N.Y. 11944
OWNER PROPERTY ADDRESS: 36 Middleton Road
Greenport, N.Y. 11944
TELEPHONE NUMBER OF CONTACT PERSON: (516) 477-0573
TAX MAP NO. : Section 041 Block 2 Lot 12. 1
CROSS STREET: Washington Avenue
BUILDING PERMIT NUMBER CROSS REFERENCE:_
•
Si /nature of Ap.licant
RECEIVED BY: •
Town Clerk's Office
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