HomeMy WebLinkAboutWhelan Sid ®�f0� .1",p =1",p -`.
JUDITH T. TERRYz Town Hall, 53095 Main Road
TOWN CLERK : ® r : P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS t ° Fax (516) 765-1823
MARRIAGE OFFICER , aj� atire
IrTelephone (516) 765 1801
RECORDS MANAGEMENT OFFICER _�7Q1 yi.
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. 1168 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PEGGY WHELAN
Address 1 : P. O. BOX 555
City St Zip LAUREL NY 11948
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY
DEPARTMENT OF HEALTH SERVICES. SCHD REF. #R10-94-0039
Name Of Owner WHELAN, PEGGY
Mailing Address 1 P.O.BOX 555
City St Zip LAUREL NY 11948
Property Address 1 MARRATOOKA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 2 lot 27.000
Cross Street PARK AVENUE
Building Permit Number Cross Reference:
Issue Date: 7/20/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY % • Town Hall, 53095 Main Road
TOWN CLERK = rZ 1 P.O. Box 1179
U' �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
® .*X" tl Fax (516) 765-1823
MARRIAGE OFFICER ' b •' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER �=7®1 ,�
FREEDOM OF INFORMATION OFFICER ��,�, ii�
i /1°l
OFFICE OF THE TOWN CLERK !Tt r s ___j. - mi,
TOWN OF SOUTHOLD , Ii{�t,-Al.(_ic,Y E i
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TO: Southold Town Building Departmenta �j� `� �� I
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FROM: Linda J. Cooper, Southold Town Clerk's Offic= % ° l,' U _i
DATED: July 8, 1994 1 •
Transmitted herewith is a copy of application No. 1212 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peggy Whelan
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 tV
DISAPPROVE ,
Comments: c_rd/�/� / 4 /0®,' _ O O 3
i Qr
RECEIVED
JUL 201994 c=== -7— --4e 7,:‘, /-X___
Tows Clerk Southolii
Signator
7-,// 5. .
Dat
-
OFFICE OF THE TOWN CLERK cvFFO( rC
Town of.Southold `k.DS Application No./ /c2"
Judith T. Terry, Town Clerk ="= -, Pp
Town Hall, 53095 Main Road ' � � Construction
• P. O. Box 1179
Southold, New York 11971 ��, Alteration'-
Oj t �0��
Telephone 4410; Residential
(516) 765-1801
;Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL`
Ill EC,EivED
Permit No. : JUL.. 8 1994
Fee $ South id 'own Clerk
DATE
APPLICANT NAME: Pew/ 4,3 Ai AA(
APPLICANT ADDRESS:
SEPTIC CESSPOOL f�
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /.h
LOCATION MAP: Must be attached hereto before permit may be issued.
- LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: •
OWNER OF -PROPERTY: Wh/%
OWNER MAILING ADDRESS: 0 /3o2(•
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 44_ ,i/.. ,` 4Fi93
TAX MAP NO. : Section j672 Block Lot 67 7
CROSS STREET: ; P�
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Signature of App 'cant
1
RECEIVED BY: •
Town - k's 0 fice
DATE: '
J/ SUFFOLK CO. HEALTH DEPT APPROVAL
I
I HO �6v / POOL' i H.S. NO. C
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MAP F FRCP 2 '( ° �I
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i U2i/EYr✓- POS-- 1 I
1 — 1\ --_ (" ( f` 1....:''.
.} 1 1 t' !',/4,._ ' r r �. STATEMENT OF INTENT
/ 1 ' ` ` v W--I L f \J I THE WATER SUPPLY AND SEWAGE DISPOSAL
_ SYSTEMS FOR THIS RESIDENCE WILL
1 / \ ORiVE 3r f - CONFORM TO THE STANDARDS OF- THE
' �. PRO o, .__
p, I cu k..4 rT'T UCte. i SUFFOLK CO. DEPT OF HEALTH SERVICES
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p{LOP- `` i �' G1 �� SERVICES — FOR APPROVAL FOR !
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