HomeMy WebLinkAboutFauvell, Jeannine '°,, iii___
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ELIZABETH A.NEVILLE lite, 4 Town Hall,53095 Main Road
TOWN CLERK %% o - P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS
v, f+r Southold, New York 11971
MARRIAGE OFFICER . 0,ji � �1l, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =_�Ql .0F.. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ �Ai r " southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2810 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JEANNINE & DANIEL FAUVELL
Address 1 : 9 WOODHOLLOW ROAD
City St Zip SMITHTOWN NY 11787
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-01-0246
Name Of Owner FAUVELL, JEANNINE & DANIEL
Mailing Address 1 9 WOODHOLLOW ROAD
City St Zip SMITHTOWN NY 11787
Property Address 1 3625 KENNYS ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 1 lot 23.002
Cross Street LAKE DRIVE
Building Permit Number Cross Reference:
Issue Date: 5/17/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ���� Town Hall, 53095 Main Road
TOWN CLERK O - % P.O. Box 1179
h z $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER `� ,fiL ���I', Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =._7Q! jili �a�,i Telephone (631) 765-1800
FREEDOM OF INFORMATiOk. a - ER ���� southoldtown.northfork.net
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S ? OFFICE OF THE TOWN CLERK
\..\\\.:I`{ 8 ? `t 17 TOWN OF SOUTHOLD
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TO 1. `fl ' ,=..
h : t. own Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 7, 2002
Transmitted herewith is a copy of application No. 2917 for a Cesspool/Septic Tank Construction Permit
submitted by:
Jeannine& Daniel Fauvell
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: 11c" 1-4 . g--Ars-;lar-e-lee.ig,c4t .
1
71/(~4091
Signature
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Dated
•
,- OFFICE OF THE TOWN CLERK 1,''0f ilkti- _ (� I
TOWN OF SOUTHOLD �'�O+�l GV Application No.)"I 7
ELIZABETH A.NEVII IF,TOWN CLERK
O
P.O.BOX 1179 ;� Construction
SOUTHOLD,NEW YORK 11971 Z
Alteration
Telephone O,l' lb
$10.00 - Residential v
(516) 765-1801 -. 1 * /`of'" $25.00 -Non-Residential
.,,_I,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE linay 6,
62 W
APPLICANT NAME: .�'yti`' I f/LfL [ niI/ UV/ d
APPLICANT ADDRESS: 060140/rep ' d ,
vii , AY - 71787
SEPTIC CESSPOOL
DESCRIPTION OF- PROPOSED CONSTRUCTION OR ALTERATION
i -paryy 3 eg Parc w/odz-frt3-L-
LOCATION MAP: Must attached hereto before permit may be issued. tl,6h%ei IQtoe Ii
LOCATION OF PROPOSE, CONSTRUCTION OR ALTERATION-
OWNER OF PROPER, 'i' : . t �,�_ — -=',�. s �_ ,
OWNER MAILING AUiAtESS: 1,41000014c.Z `/( of
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Mt fih_12)wn1 /0 Pile-7
OWNER PROPERTY A..uDRESS: 3&/c)5 Ken neyiS ,`
Se! 'tom/di 7
TELEPHONE NUMB: OF CONTACT PERSON: ( 3 ) •7d `t" ,), ,E'6 /
TAX MAP NO. : Sec °eon 3 7 Block O / Lot 61. 0
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CROSS STREET: LaL� `/1/�
BUILDING PERMIT NUMBER CROSS REFERENCE:
/9-t----ft-it..,--p-x- 16L-1"4-1--"0
ignature of Applicant
RECEIVED BY: 'ii. 0 4
DATE: 5-/co (c) Town Clerk's Office
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