HomeMy WebLinkAboutLynne ,,,ice
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ELIZABETH A. NEVILLE ���� 1 ; Town Hall, 53095 Main Road
TOWN CLERK % = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER � 4#0*
i Fax, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER
--
RECORDSiNg 4a®iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���� southoldtown.northfork.net
OFFICE OF THETOWNCLERK
SOUTHOLD WAS NENWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2921 N Residential Non-Residential X
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : NANCY STEELMAN
Address 1 : 25235 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
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 #C10-01-0012
Name Of Owner LYNNE, MICHAEL
Mailing Address 1 36225 MAIN ROAD
City St Zip CUTCHOGUE • NY 11935
Property Address 1 36225 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 97.00 block 1 lot 25.001
Cross Street BRIDGE LANE
Building Permit Number Cross Reference:
Issue Date: 10/30/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �� ;eo"��; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 1 Southold, New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
:®o� � �1
ER
RECORDS MANAGEMENT OFFIC � $®z . . ��„�i� Telephone (631) 765-1800
FREEDOM OF INFOR1VIATION-QFEIaR
of southoldtown.northfork.net
_ FFICE OF THE TOWN CLERK
nij 15 2002 ,-�
` +p TOWN OF SOUTHOLD
TO: TOW. o�i.tlio6ld
own Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 15, 2002
Transmitted herewith is a copy of application No. 3040 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Nancy Steelman
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.
4 ,
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Signature
Dated,//0//:5—A2—
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OFFICE OF THE TOWN CLERK i �tFIR
FTJ7ABETTWTOANOEvlr.00F UTTOWNC EIuc LD /�%V5 rl C• • Application No. O
P.O.BOX 1179 iC ,
Construction
SOUTHOLD,NEW YORK 11971 _ ;
_ `� • rri Alteration
Telephone ,� �Q�it $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 iOcr, IIS 2OZ,
APPLICANT NAME: Wahcq Steojrnan
APPLICANT ADDRESS:
J !II_ : •3<5
SEPTICX CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
NhAL) h i-k r y611sfem 66 approved by 6 .1-1,1)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: •
• OWNER OF PROPERTY: l\'lj� / L hie
OWNER MAILING ADDRESS: 56225 Miry kel
f fy //935
OWNER PROPERTY ADDRESS: , }r-
TELEPHONE NUMBER OF CONTACT
TACT PERSON: 734- �4(p,5
a
TAX MAP NO. : Section SS Block 2. Lot /o.
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CROSS STREET: 8r/4,?-10.91)e.,
BUILDING PERMIT NUMBER CROSS REFER NCE:
f
•
/ 'nature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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EMPLON
1 n No FINAL APPROVAL WITHOUT
STORM I
,l_, I (SD1
Z J _1 APPROVAL BY HAZARDOUS MATERIALS
i z 1 SU`FOLK COUNTY DEPARTMENT OF HEALTH SERVICES
APPROVED FOR CONSTRUCTION ONLY
H.S. REF.NO.
C/O — e/ — oo/a FLOW i)97 3 P-P
TYPE w/N 6',2';' - .D 17/onl
This approval is granted for the construction of the sanitary
to disposal and water supply facilities pursuant to Articles VS and
0 7 of the Suffolk County Sanitary Code and is not an expressed
I ncr implied approval to discharge from or occupy the PUBLIC
structure(s) shown. THIS APPROVAL EXPIRES THREE (3}
STORM I
YEARS FROM THE DATE BELOW. (SD)
APR 0 3200
DATE SIGNATURE
1