HomeMy WebLinkAboutKelemen S ELIZABETH A. NEVILLE ff~'~Xl~ Town Hall, 53095 Main Road
TOWN CLERK ~ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (631)/765-1800
FREE~OM OF INFO~V~ATION OFFiC~ER south~ldto~/orthfork.net
- , TOWNOr SOUTHOL.
TO: Southold T0~n gU}lding Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED' October 25, 2002
Transmitted herewith is a copy of application No. 3051
Permit submitted by:
for a Cesspool/Septic Tank ALTERATION
Peconic Cesspool for Kelemen
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: L~//
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
Dated
Stephen Kelemen
77 Main Road
Orient
o~'1me OF ~ TOWN CLE3.K
ToWN O~' 8OUlllOLD
F~BT~ A. NEVUI~, TOWN CLERK
P.O. BOX 1179
SOUTItOLD, NEW YORK 11971
Telephone
(63t) 765-1800
Application No.
Construction_ .
Alteration
$10.00 -P, esidential
$25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSFOOL
EECEIVED
Permit No.
Fee '$
APPLICANT NAME:
PECONIC
DATE
CESSPOOL
APPLICANT ADDRESS: P.O. BOX 972
MATTITUCK, NEW YORK 11952'
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRE~'~:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OU CONTACT PERSON:
TAX MAP NO.: Sectio ~ ~ Block ~
CROSS STREET:
BUILDING PERMIT NU,1BER CROSS REFERENCE: "
RECEIVED BY:
DATE:
Signature of ~i~plicant
Town -~[~'-~k~s Office