HomeMy WebLinkAboutKick ELIZABETH A. NEVILLE � 0 'yJ►; Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
`yy,
® Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �. +t
MARRIAGE OFFICERFax (631) 765-6145
RECORDS MANAGEMENT OFFICER `= ®l 40.,•�, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - r�'� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2757 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CHRISTOPHER BAUDO
Address 1 : PO BOX 405
City St Zip ST JAMES NY 11780
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 #R10-00-0010
Name Of Owner KICK, RICHARD E MARIA
Mailing Address 1 8 WAGNER LANE
City St Zip LAKE GROVE NY 11755
Property Address 1 TARPON DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 57.00 block 1 lot 5.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 3/11/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE Iy°
®G'y�
Town Hall, 53095 Main Road
TOWN CLERK y - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
v, $ Southold, New York 11971
MARRIAGE OFFICER :oli ���� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =_ Ql ��®'i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD R
LT: TT:1)1
TO: Southold Town Building Department
1110) to
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 1, 2002
Transmitted herewith is a copy of application No. 2862 for a Cesspool/Septic Tank Construction
Permit submitted by:
Christopher Baudo
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:
714494—
Signature
.0, --71/0
Dated
OFFICE OF THE TOWN CLERK ,''',,,.,....,,,,,,
c�vFFULKCpGy
TOWN SOTJTHOLDOF �
�.. Application No.a Olo9.Th
ELIZABETH A.NEVILLE,TOWN CLERK 0
P.O.BOX 1179.. Construction✓
SOUTHOLD,NEW YORK 11971 orn
Ln •
Alteration
Telephone 0,j- �Q�';�� $10'.00 - esidential
(516) 765-1801 - l ��'� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED
APPLICATION
for
FEB 282002
CONSTRUCTION or ALTERATION PERMIT
Southold Town Clerk
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$ - -
DATE ///2/0 0
APPLICANT NAME: (/h`'/ 4e'/' B.ateed-o
APPLICANT ADDRESS: a. gax 10.E
,'5. tlahl e-s / P.V. / /7S6
SEPTIC ✓ CESSPOOL ✓
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
d'/17,9 /8 7 ?/3 i`y 2 2 is 'oil/ f widener e.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR
OR ALTERATION:
OWNER OF PROPERTY: /� /c 4 2/"G � 02112 Md..
OWNER MAILING ADDRESS: a vv ayh &/' 1 ah e
Lake Gro rye /t/, Y, // 7s..5-
OWNER PROPERTY ADDRESS: 7.47/720/1 L ,-,i'&
SIO yttio/4' / /U. Y
TELEPHONE NUMBER OF CONTACT PERSON: 6. 3/ 09 / 9 - .9l44
TAX MAP NO. : n
Section{ i/2 /�57 Block-/ f Lot 5
/�'f
CROSS STREET: Qat(
BUILDING PERMIT NUMBER CROSS REFERENCE:
5AMA/Ilif
Sig ature of Applicant
RECEIVED BY -
)
To Clerk's Office
DATE: a\a. ,6
.
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