HomeMy WebLinkAboutGraham, Newell �.
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~ Town Hall, 53095 Main Road
oftW�$ P.O. Box 1 179
O �0�..' Southold, New York 11971
JUDITH T.TERRY
--...71/0/__ 1 ..•01
TELEPHONE
TOWN CLERK �����//����I (516) 765-1801
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. 405 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : KMA BUILDERS INC.
Address 1 : 10 DEBBIE TRAIL
City St Zip HAMPTON BAYS NY 11946
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY SUFFOLK COUNTY DEPARTMENT OF
HEALTH SERVICES ON 9/13/88.
Name Of Owner GRAHAM, NEWELL AND GLORIA
Mailing Address 1 6 HORACE PLACE
City St Zip SEA CLIFF NY 11579
Property Address 1 PLUM ISLAND LANE
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 6 lot 11 .000
Cross Street KING FARM ROAD
Building Permit Number Cross Reference:
Issue Date: 10/05/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
qo S
FOLke-
BLD crl Town Hall, 53095 Main Road
G.DEPT �" P.O. Box 1179
AWN OF SOUTHOLD
Y
Southold, New York 11971
JUDITH T.TERRY
rte,<.r TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR 01 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: September 30, 1988
Transmitted herewith is a copy of application No. 412 for a Cesspool/
Septic Tank Construction Permit submitted by:
KMA Builders Inc. for Mr. and Mrs. Newell Graham.
•
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
Comments: 0. ....�.�. a' � Gin ate.c, .-Th d. i
‘.k . Erv, 1111\ii
`rat-e.m., 4.4,12
Signature
Dated
o
'�
OFFICE OF THE TOWN CLERK CjV M/rCO
Town of Southold Application No.
Judith T. Terry, Town Clerk .•G
Town Hall, 53095 Main Road Construction
P. O. Box 1179 . *./ Alteration
Southold, New York 11971 ,yam ��-
es
Telephone 01 41 �� �� 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 S EP t cj ( c/R67
APPLICANT NAME: I C-ot1-P .
APPLICANT ADDRESS: f2, ice%c s L H Pc, 11.0',i 1+3ct
SEPTIC ✓ CESSPOOL ✓ baa -� l�5 l
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: A>JDR,Eo,SJ t ci\Vt -t Sik► •.4l&t-1 pr 4 S
OWNER MAILING ADDRESS: 304, w 3G.` " S l E2.r� .l
P- 0 N ..(. 10443
OWNER PROPERTY ADDRESS:
L- uC Is16 - -
TELEPHONE NUMBER OF CONTACT PERSON: ca 1c).. 4,0 1 -
TAX MAP NO. : Section /03 Block Lot 3 '7. 3
CROSS STREET: k h 6 Q`Z/ l2
BUILDING PERMIT NUMBER CROSS REFERENCE:
- /III .
Signature of ;'pplicant
RECEIVED BY:
Town Clerk's Office
DATE:
1
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. ... • ' •' .•t ,.,* SUFFOLK CO. HEALTH DEPT. APPROVAL
H. S. NO
4,,, [ SINGLE FA ILY DWELLING ONLY
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STATEMENT OF INTENT
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'4:4,4:-. .' ,, ,,,:, .,..„1„...e.s, ,.,... ..' . •-,.....:-.4... NTHE WATER SUPPLY AND SEWAGE DISPOSAL
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-vACAT) hi
SYSTEMS FOR THIS RESIDENCE WILL
. 11 CONFORM TO THE STANDARDS OF THE
, ' ', ' • " ' V• 'i - s '- ' ' 912.0 P ..,,f7r, - '• 4 SUFFOLK CO. DEPT. OF HEALTH SERVICES
‘1#,J2esiclei,ktei .' -:!* ''• l' ''1,-,. /
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SUFFOLK COUNTY DEPT. OF HEALTH
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1101••• . ..- SERVICES - FOR APPROVAL OF
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CONSTRUCTION ONLY
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SUFFOLK CO. TAX MAP DESIGNATION:
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114K:04UMEt,4-1 DIST. SECT. BLOCK PCL
1000 103 4
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OWNERS ADDRESS:
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