HomeMy WebLinkAboutKerbs ELIZABETH A. NEVILLE "WI °O� : Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % <x y yw Prw Southold, New York 11971
MARRIAGE OFFICER ®� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ? ®� „u i Telephone (631) 765-1800
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. 2502 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JON C. KERBS
Address 1 : 440 RILEY AVENUE
City St Zip MATTITUCK NY 11952
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 # R10-99-0061
Name Of Owner KERBS, JON C.
Mailing Address 1 440 RILEY AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 440 RILEY AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 54.00 block 6 lot 4.004
Cross Street SOUNDVIEW AVENUE
Building Permit Number Cross Reference:
Issue Date: 2/06/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
' 0?6 )
ELIZABETH A.NEVILLE t� 7. : Town Hall, 53095 Main Road
TOWN CLERK y _ P.O.Box 1179
REGISTRAR OF VITAL STATISTICS V Southold, New York 11971
MARRIAGE OFFICER . y,L `. Fax Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =_ 70( .�� ii� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,,,•
�'
OFFICE OF THE TOWN CLERK (� 't (` + � v'^
TOWN OF SOUTHOLD I
tt 2. 6 2001 _.
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office -
DATED: January 26, 2001
Transmitted herewith is a copy of application No. 2. 590 for a Cesspool/Septic Tank Construction
Permit submitted by:
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:
c A-41 A
Signature
4a-lo 1,6 l
Dated
1. •
/111////1/111'''
OFFICE OF TIDE TOWN CLERK , qf Wr l
TOWN OF SOUTHOLD � �J QQG �11�i Application No. .JJ
ELIZABETH A.NEVILLE,TOWN CLERK ,i 0
P.O.BOX 1179Construction
•
SOUTHOLD,NEW YORK 11971 ; =v •• inr=n
Alteration
•
Telephone O,f �'�••• $10.00 - Residential
1'
(63T) 765-1800 �l' 1*/�;,ef' $25.00 -Non-Residential
•TOWN OF SOUTHOLD
n4y��c v
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED
APPLICATION • JAN 2 5 2001
for ii*wr Cierk
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE / ) 5 0
APPLICANT NAME: .d C-
APPLICANT ADDRESS: L{ 0 se 4."e_
‘Ac.Ai .,, /V) lt`lSZ
SEPTIC X- CESSPOOL
DESCRIPTION OF PROPOSED C NSTRUCTION OR ALTER N
I r�
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION Oyt ALTERATION: •
• OWNER OF PROPERTY: LSA
OWNER MAILING ADDRESS: 11 ((O e(t.„.,
OWNER PROPERTY ADDRESS: CG`^k-- ..
TELEPHONE NUMBER OF CONTACT PERSON: .2 q S/- S S1
TAX MAP NO. : Section 5- (( Block 6 Lotg.T '. 7
CROSS STREET: j�1vJ�w 6vse--
BUILDING PERMIT NUMBER CROSS REFERENCE:
gnature of Applicant
RECEIVED 13Y:
Town Clerk's Office
DATE:
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