HomeMy WebLinkAboutHermance ',
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ELIZABETH A.NEVILLE
TOWN CLERK o - P.O. Box 1179
vs
REGISTRAR OF VITAL STATISTICS riv Southold, New York 11971��
MARRIAGE OFFICER � t, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER _�®� $ i,� Telephone (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. 3004 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SAMUELS & STEELMAN
Address 1: 25235 MAIN ROAD
City St Zip SeliTHOLD CUAKo&UE NY 119 3s
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 #R10-02-0129
Name Of Owner HERMANCE, RONALD
Mailing Address 1 327 MCKINLEY PLACE
City St Zip RIDGEWOOD NJ 7450
Property Address 1 240 BRIAR LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 81.00 block 1 lot 16.008
Cross Street NORTH BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 2/18/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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4 ELIZABETH A.NEVILLE ��e�� �' Town Hall, 53095 Main Road
TOWN CLERK % ® - % P.O. Box 1179
% Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V" ��
MARRIAGE OFFICER ; Fax l����� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER -__"�®� �a�® i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ��������,�'�� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK ------ -,,-1
TOWN OF SOUTHOLD ;7 T T-. t ( ' 9
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TO: Southold Town Building Department ,'k FEB
4SD : , . i
FROM: Linda J. Cooper, Southold Town Clerk's Office S : - ,-.;,D
DATED: February 4, 2003
Transmitted herewith is a copy of application No. 3126 for a Cesspool/Septic Tank Construction
Permit submitted by:
Samuels & Steelman for Ronald Hermance
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: ►<+r _
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Signature './ �
Dated
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OFFICE OF THE TOWN CLERK ,,''',,••►► ►,,,,�
S�FF -
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TOWN OF SOUTHOLD ` Q//�; Application No3 '
ELIZABETH A.NEWT LF,TOWN CLERK O 7
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 Z
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Alteration
Telephone 0•� �Q��'� $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 rs, ui�,g y L?i �0a
APPLICANT NAME: (94-#1ciFa 0 oYre-;z/fl lv /4-h-cm-r cToS
APPLICANT ADDRESS: 50`735 ,724M/ c O >7
6ccraito6-067,-, //F35
SEPTIC ✓ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION A/
,r e4_,I ,' .7t ae 4(-e 7)69-0-e llc96ed6 614.41 y
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: .
OWNER OF PROPERTY: Aga-ed f&rm ,rye.
OWNER MAILING ADDRESS: 3617 /22K1
AI dg.2 t()O C7d /� O'74150
OWNER PROPERTY ADDRESS: 021-740 re, 14-)t L,4i(/6T
r vTffoc,0 A4
TELEPHONE NUMBER OF CONTACT PERSON: Zb#-yr Vetki4. :Ge./.--tt
TAX MAP NO. : Section OP/ Block O/ Lot /6, g
CROSS STREET: A/O4TH i&4-911/.PUI
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: /
.\ L.‘..J'‘..i r-t I I1/4,JI V IVI/'1F.
240 BRIAR LANE
SOUTHOLD, NEW YORK
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