HomeMy WebLinkAboutSchiller, Edward I0 03cO
ELIZABETH A. NEVILLE /= Gy�; Town Hall, 53095 Main Road
TOWN CLERK ; y P. O. Box 1179
�y, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Oy O ��1, Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER = '/�l 4r•,6,,� Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER 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. 2823 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EDWARD SCHILLER
Address 1 : 540 CEDAR DRIVE
City St Zip CUTCHOGUE NY 11935
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 #R10-02-0078
Name Of Owner SCHILLER, EDWARD
Mailing Address 1 540 CEDAR DRIVE
City St Zip CUTCHOGUE NY 11935
Property Address 1 225 PINE TERRACE
City St Zip EAST MARION NY 11939
Tax Map No. section 22.00 block 5 lot 6.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 6/21/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ofFotit '23
ELIZABETH A. NEVILLE �/ 4;
y ; Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS :14( 6 y �4a0r����,,�� Southold, New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Ql 4:00. Telephone Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER _ southoldtown.northfork.net
OFFICE OF THE TOWN CLERK „
TOWN OF SOUTHOLD ' w
a ! MY 2 4
TO: Southold Town Building Department --�—
BLD!.,. fl PT.
TOWN If vt`.:T140LD
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 24, 2002
Transmitted herewith is a copy of application No. 2925 for a Cesspool/Septic Tank Construction
Permit submitted by:
Edward Schiller
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:
2 7,
Signature
Dated
OFFICE OF THE TOWN CLERK �,°' t BL f�
TOWN OF SOUTHOLD .!'O� �1 414%
1 Application No. �Q�C
ELIZABETH A.NEVILLE,TOWN CLERK �+► y
P.O.BOX 1179 : }O Construction IV
SOUTHOLD,NEW YORK 11971 Z
NAlteration /
Telephone 0,1' oe' $10.00 - Residential 1/
(516) 765-1801 '_ '1 �b'�
� � $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
APPLICANT NAME: Edward F 5-M/II-
APPLICANT ADDRESS: 4-p ((dce, /Pd
h' 41,0 // a5"--
SEPTIC CESSPOOL
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:
OWNER MAILING ADDRESS: �2dQc�
pr�f 5li ,vV i/5
OWNER PROPERTY ADDRESS: S"—
F0 — 111.0701, N') //53?-
TELEPHONE
/q37TELEPHONE NUMBER OF CONTACT PERSON: 53/-
/000
,3/-b Op
TAX MAP NO. : Section a.2_ Block S' Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applican
RECEIVED BY: 11)CC‘t5. -1/
ITown Clerk's Office
DATE: 5-1?%Li ) `
SU1 VEY OF LOT 6 1
MAP OF H I SHPO I NT AT EAST MARION,
SEGTION ONE
FILED JANUARY II, ICt84 FILE No. 1680
SITUATE: EAST MARION
11
TOlNN: SOUTHOLD 0�N N
SUFFOLK a I. . `' OP E
��
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES e E I
SURVEYED 05-21 02 W
PERMIT FOR APPROVAL.O CONSTRUCTION FOR A
SUFFOLK COUNTY TAX #
1000-22-5-6 SINGLE FAMILY RESIOCWCC ONLY I
S {
CERTIFIED TO: 1>A+ Z/ �-/ 42_-1-1,(;.). RFRF ° �� ', .0 0 o�- O "t I.
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