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SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3957 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1: P 0 BOX 487
City St Zip LAUREL NY 11948
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELTS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner HARUN ILGIN
Mailing Address 1 175 SUMMIT ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 175 SUMMIT ROAD
•
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 9 lot 9.000
Cross Street SUMMER LANE
Building Permit Number Cross Reference:
Issue Date: 5/27/10 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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0010 S0045,-
ELIZABETH A. NEVILLE,RMC, CMC ' ,`O 0 : Town Hall, 53095 Main Road
TOWN CLERK i illi * t P.O. Box 1179
v, Southold,New York 11971
REGISTRAR OF VITAL STATISTICS G ,:
MARRIAGE OFFICER k' 0 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ..q . • 1
��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER :!OUN i�,�o��. southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK v
TOWN OF SOUTHOLD0
MAY 252010
TO: Southold Town Building Department BLDG. DEPT.
TOWN OF SOUTHOLD
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 25, 2010
Transmitted herewith is a copy of application No. 3957 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Harun Ilgin (SCTM No. 78-9-9)
Please review the application and location map and advise 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:
APPROVEi .
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
.„AV'
Signature
27"toreg. d-Co/e)
Dated
` I. r. iiia...,_,
' '• %SUFFOj,t�o
ELIZABETH A.NEVILLE �'4 * : Town Hall, 53095 Main Road
TOWN CLERK ; o P.O.Box 1179
REGISTRAR OF VITAL STATISTICS % CO Z Southold,New York 11971
MARRIAGE OFFICER O ��� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =y�IJ� .'-,.l1 Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER '1 * �',.'� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10i or Non-Residential @$25 Application No. 3 es
Permit No.
Applicant Name PECONIC CESSPOOL
Applicant Mailing Address P. 0. BOX ,487
LAUREL, NEW YORK 11948_
Septic Tank 's or Cesspool
Brief Dogiption of Pr posed Constcuption or Alteration
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Location of Proposed Construction/Alteratio :
Owner of Property: H (I iv I L L-- I
Owner Mailing Address: f ,) 5 5 LI VII 1'11 CI* R.4
C' 0,4410/(C( y I I 61--/ I
Owner Property Address:
Name and phone number of contact person i--e4e/t L ( ` i✓t.
Tax Map No: Section 7cc Block Lot
Cross Street 6'u fli at, EL L iq N L
NOTE: LOCATION MAP MUST BE SUBNIITTED, WITH AP LICATION. NEW
CONSTRUCTION REQUIRES SURVEWITH HEILTH DEPAR NT APP OVAL
Signa ure of pplicant Date
Received by: ...124---(.9- s
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ]FOUNDATION 1ST
[ ]FOUNDATION 2ND
[ ]FRAMING / STRAPPING
[ ]FIREPLACE & CHIMNEY
[ ]FIRE RESISTANT CONSTRUCTION
REMARKS:
ROUGH PLBG.
INSULATION
FINAL
FIRE SAFETY INSPECTION
FIRE RESISTANT PENETRATION
DATE