HomeMy WebLinkAboutKlijian ELIZABETH A.NEVILLE �0 :},rp, " ��� Town Hall, 53095 Main Road
TOWN CLERK ; , . i P.O. Box 1179
`8 ;,.- '• Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ® ';rQ ;, ��
MARRIAGE OFFICER 1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �� �1.1 ,ss22, �ti� ii�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �`zs' "
•
OFFICE OF THE TOWN CLERK
SOUTHOLD TPLAWIRIDEASCEIRTHOIRDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2612 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : WILLIOW RUN MANAGEMENT
Address 1 : 263 13TH AVENUE
City St Zip WEST BABYLON NY 11704
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 #R10-01-0077
Name Of Owner KLIJ IAN, ANTUAN
Mailing Address 1 17138 SIMONDS STREET
City St Zip GRENADA HILLS CA 91344
Property Address 1 630 WILD CHERRY WAY
City St Zip SOUTHOLD NY 11971
Tax Map No. section 52.00 block 3 lot 15.000
Cross Street BAYBERRY
Building Permit Number Cross Reference:
Issue Date: 7/24/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
1.
1v 6711.:
�ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
REGISTRAR OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER •t � �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER 41
11� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ����
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 28, 2001
Transmitted herewith is a copy of application No. 2699 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Willow Run Mgmt Corp for A. Killian
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: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
ignature
- ot
Dated
4, �4
„ /////ILII
OFFICE OF THE TOWN CLERK 11'' •�
TOWN OF SOUTHOLD ,‘`'Q WA.; Application No. ,2e.0 191
ELIZABETH A.NEVILLE,TOWN CLERK
Construction
P.O.BOX 1179 }� _
SOUTHOLD,NEWYORK11971 p • rT+ Alteration J
Telephone s O,j. �Q�i1 $10.00 -Residential
(631) 765-1800 > � ,'” $25.00 -Non-Residential
• .,.,,,,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE ik2'c f®
APPLICANT NAME: W.1.kiU
APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Com `f-e. 09 c-1y b ei
7
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: jqiti7 j !T/' 9A( 11I,AA%
OWNER MAILING ADDRESS: 4,s',f" S 'i d'4Ur e dr-
To-ver4V0///A1 y 71,7/ ept owl
OWNER PROPERTY ADDRESS: GpcS v )
TELEPHONE NUMBER OF CONTACT PERSON:3-Oh4 ' kLr if eLl 7 cSH �fl
TAX MAP NO. : Section — Block 3 Lot Is— •
CROSS STREET: '/i P2-1'7
BUILDING PERMIT NUMBER CROSS REFERENCE: .
•
Signature of Applicant
RECEIVED BY: E._-J
Town Clerk's Office
DATE: „7-2.(e/(5-
J
• .i. 1..0. .\•...• .A•.• ••.\. , .�....
i) ,SSPPOLK COUNTY DRMRT i6N,or'FiCALTH SERVICES'
�03w. LA N D SG
PERMIT FOR APPROVAL Of CONSTRUCTION FOR A LI q
v J 0' `Ew��p 9`4,
' SINGLE FAMILY RESIDENCE ONLY • OI.
� �'`; �� 9
. 4 E ,tgolt-Fii'f 7 :
a1
®ATE` 01 �-1 �� 4 .„.rt. / ri<s
APPROVED .„
.?ift.7:,
k
FOR MAXIMUM OF ,BEDROOMS ,�� * ��Op NEyy V°'
EXPIRES THREE YEAR'S FROM oATE OF APPROVAL
NNs
�
j EXCAVATION CAVATIQN ''
,`FJrFG ”4912/1/ /2 FO �� A •' ��-� /�\
�1 8Y9RE / 1' l__ / '
` 'a4co 20� , BY H. LTH D_PARTME k
/M,o 1p
2,,,, 'T 19,4 '9'J t." /1
/-riki‘ez•Z.z 1 l'ipitil /
yAYc>PA/T
/[1((/
v
1 .
jA, ,
N ..„
4 /t/ 33'/4{1440', ✓"o,00 ' /
Ni(
e _ ,94.5,0- • /
/ ' .1.---N\ \, N• --'.%
IF
,Vo op�ti',s"4,e - s t!. AlAP V
A, \ \
NI �a, `oma. Q iAO‘°' :'-',N,..
��,._,.ti GJr 11
- --.- r
,/ (1 ...... "�., n.
,,..„,
,11 9? t
J (11'i,`'
. , i, \
bf
Ili
® 7. r ov. ,.„,„
et
jp
0 0.11 CA AV
�
it Cj V cam, J.ca.
- 1 N0/pry , 454
z lo
1 14
0 7e.c.),,), - N — 'el
143 a ,�J
/S/`</O it/. '0,.: To
D
N �01,� -.$y vv
Q THZa es"G
4
.0, •
• �� V hl 9T eI�J egewv —_—,i45
y i424)A ToCcn•UVx° -$R1
17'
,l,-Tc'Se4'/42c.Fo///9/? F),•12 75rdna--
�rEY.�e. 4,t.17%),4941 �4/✓/A,11 ' ' ,44/^44141K144LEe•f/.4�v�toes�.t'i'
/or- /� /4r1,V DF�//O'�EGeze✓T r'' 4. . . --,]j1:14,./:?,c3.4%),,,(4/448,reiV0• k
.e&-,./ 5,4,-42?)e./a5,zoa/ i
7k07/1041,A9.048.1/),v6 z, 2vc/
®.y7ep'is'.c.'cf, .3/ Zoo/ '
/Dam- -.6 -