HomeMy WebLinkAboutKaufman, Gene EI,IZ,~BETH A. NEVHJ.E
TOWN CLERK
REC-ISTRAR OF VITAL STATISTICS
mOE OFFICER
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FREEDOM OF LNFORNL~TmN OFI~R
_FFICE OF THE TOWN CLERK
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TO: ;.---~-' Southold Town Building Department
Town Hall, 58095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: April 13, 2004
Transmitted herewith is a copy of application No. 3303
Permit submitted by:
for a Cesspool/Septic Tank ALTERATION
Peconic Cesspool for Gene Kaufman
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.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE, ~.~ '
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
- Signature
GRACE KAUFMAN
1570 MASON DRIVE
CUTCHOGUE
o~rlre OF TH~ TOWN CLg~%C
TOWN OF 8OUTItOLD
J 7~T~ A. N~VI! ] ]~; TOWN CIJ~RK
P.O. BOX 1179
SOI~TIIOLD, ~W yORK 11971
Telephone
(63~)
TOWN OF SOUTNOLD
Application N .o~)J
Construction /
Alteration
$10.00 -Residential ~
$25.00 - Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
APPLICANT NAME:
DATE
PECONIC 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 CONSTR.~TI_ ON OR ALiERATION:
OWNER DP PROPERTY:
OWNER MAILING ADDRES5',~
OWNER PROPERTY ADDRESS: ../57~ ~~ ~
TEL~P.ONE .U~e~R OF CO.T*CT PERS(~.:
TAX U*P .O.: Se~tio. /~_~o~ 7 Lot
CROSS STREET: ~~~ ~,
BUILDING PERMIT NUMBER CRO$,~* REFE ~:.NCE:
~.;ignature of Appli~f,&nt '
RECE,VED .,:
/ To)~n Clerk's Office