HomeMy WebLinkAboutJacques ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
62
REGISTRAR OF VITAL STATISTICS • 0' Southold, New York 11971
MARRIAGE OFFICER • ®�i 4r
�10 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ?*04, Woo Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,,'� �
OFFICE OF THE TOWN CLERK
SOUTHOLD TOWNEMAsTSTROIMEIDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2676 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PETER JACQUES
Address 1 : MAIN BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
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 #R10-99-0209
Name Of Owner JACQUES, PETER
Mailing Address 1 11185 MAIN BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 4079 MAIN BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 2 lot 18.002
Cross Street BBAYBERRY ROAD
Building Permit Number Cross Reference:
Issue Date: 10/18/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �e '� ; Town Hall, 53095 Main Road
TOWN CLERK H Z ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS AS 1 Southold, New York 11971
MARRIAGE OFFICER ®?i ,1+� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER "'/®l $S.0 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: October 16, 2001
Transmitted herewith is a copy of application No. 2768 for a Cesspool/Septic Tank Construction
Permit submitted by:
Bruce Anderson for Peter Jacques
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:
Signature
t9G-e- /
Dated I
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OFFICE OF THE TOWN CLERK , "„n•• ���
�FFOLk
TOWN OF SOUTHOLD , ;00� `QGy` ' Application No..2 7 4
AT.T7ABETH A.NEWT IP,TOWN CLERK �.
P.O.BOX 1179 iG ; Construction
SOUTHOLD,NEW YORK 11971 c •
�rn ;
• tP � �. Alteration
Telephone � Q�'i $10.00 -Residential v
(631-) 765-1800 1 ,,10' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE ley% `S,
APPLICANT NAME: ;w
APPLICANT ADDRESS: ` -
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION s(tot7i.�_
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 7?'/ .c
OWNER MAILING ADDRESS: / //$sem, kle.4 ,. Ulr ..t..-ic-k-
doL2.I( .11 w1 ! C 5 Z
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OWNER PROPERTY ADDRESS: ` �- 617 4.14-4-3 fj
`wuci 4 . A----(1"1""---
TELEPHONE NUMBER OF CONTACT PERSON: <-37.-r? C.
TAX MAP NO. : Section -78 Block Lot / O , z®
CROSS STREETrA47L.Ge,vw^
BUILDING PERMIT NUMBER CROSS REFERENCE:
• Iler
Signature of Applicant
RECEIVED BY: AL-
Town
I --Town Clerk's O'ffic.e
DATE: / G'hb—/o/
SURVEY OF PROPERT
• AT BAYVIEW
TOWN OF SOUTHOLD
SUFFOLK COUNTY , N,
1000-78-02-18.2
SCALE: 1"=40
AUG. 12, 1999
AUG. 25, 1999 ( prop. hse. I
FEB. 7, 2000 ( additions 1 -
AUG. 11,2000 (we//, CP loc. 1
NOV. 20, 2000 ' prop. hse. )
DEC. 8, 2000 :' w/s line )
SUFFOLK COUNTY DEPARTMENT;OFHEALT SERVICES
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PERMIT FOR�PR®VKpOF CONSTRUCTION F®R9
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SINGLE FAMILY RESIDENCE ONLY elQi6i�
DATE I2 zc?i--00 HS REF.NO. (`:i0-5c2--< 2o? SFr. ,7,
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APPROVED ,.
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FOR MAXIMUM OF Mt hOOMS \ .t.P.p> 70 *0.
EXPIRES THREE YEARS FROM DATE OF APPROVAL �``� 8j. 0 'C',�.ty,4,. <o
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