HomeMy WebLinkAboutSurprenant JUDITH T. TERRY
Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � .�` Southold, New York 11971
MARRIAGE OFFICER �® o Y Fax (516) 765-1823
® �� �!6 Telephone (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. 811 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : RONALD W. SURPRENANT
Address 1 : P. O. BOX 201
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
MONDERNIZE PRE-EXISTING SYTEM IN SAME VICINITY.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED. CALL THE
BUILDING DEPT. 765-1802 FOR AN APPOINTMENT.
Name Of Owner SURPRENANT, RONALD W.
Mailing Address 1 P. O. BOX 201
City St Zip GREENPORT NY 11944
Property Address 1 62455 NORTH ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 40.00 block 1 lot 6.000
Cross Street CHAPEL LANE
Building Permit Number Cross Reference:
Issue Date: 3123/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.. - ... //
JUDITH T. TERRYTown Hall, 53095 Main Road
TOWN CLERK ® �; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` Southold, New York 11971
MARRIAGE OFFICER " ' -� ��� Fax (516) 765-1823
4s. Fax
(516) 765-1801
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OFFICE OF THE TOWN CLERKS lk O '
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TOWN OF SOUTHOLD '----1( ti
MARCH 9, 1992 ' 9 0992 ,,.
TOWN eSd�J►rtGLi7 I
To: Southold Town Code Enforcement 'Officer `�'~• z z_ a�
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A830 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
RONALD -W. SURPRENANT: .
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 recommendation:
APPROVE - X
DISAPPROVE -
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Date "Fawn Clerk S`ouff(o(d'
OFFICE OF THE TOWN CLERK ,,,'"'"" ,
Town of Southold ��.'Oc.� fgUr OG _ Application No.
Judith T. Terry, Town Clerk �� �, y
Town Hall, 53095 Main Road ;� =41
Construction
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P. O. Box 1179 4=2
r rn ; Alteration -"-
Southold,
Southold, New York 11971 • tn -2 * .`
Telephone ;10�, - �Di', $10.00 - Residential
(516) 765-1801 ' l
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
•
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE /�/q�
APPLICANT NAME: ?OA// Lu , Pie&-NAv
APPLICANT ADDRESS: PO ,GU)( .2-01 /4/6i7/F /Z6
SEPTIC ../ CESSPOOL
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DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
U C»Ai/2 P2 - STi.,u& 3)'S TT7 /42 w/
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: (<2cw,4 - -S->,()/ P/ v, ,,u
OWNER MAILING ADDRESS: S)/ /6-
OWNER PROPERTY ADDRESS: A.) kTJ R D •
- EA Pc R T /JV /f?
TELEPHONE NUMBER OF CONTACT PERSON: ' `� < </-O6-.r6/92 ^0`j
TAX MAP NO. : Section te6 Block Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of App cant -
RECEIVED BY:
n Clerk's Office
DATE: 3/7
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