HomeMy WebLinkAbout350 Skunk LnTown Of Southold
P.O Box 1179
Southold, NY 11971
Date: 07/26/04
Transaction(s):
1 Permits
* * * RECEIPT * * *
Receipt~:
35O4
Subtotal
$45.00
Check#: 3504
Total Paid:
$45.00
Name:
Keyspan, Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk ID: LINDAC Intemar ID: 98774
ELIZABETH A. NEVILLE
TOWN CLERK
R~GISTRAI~ OF VITAL STATISTICS
MARRIAGE OFFICER
KECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631 ) 765-1800
OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD
FAX TRANSMITTAL
To:
From:
Dated:
Re:
Janet Mitchell - Keyspan
Linda J. Cooper, Deputy Town Clerk
July 27, 2004
Excavation Permit for 350 Skunk Ln
Number of Pages (including cover): 5
If total transmittal is not received, please call 631-765-1800.
COMMENTS:
FILE No.570 07/13 '04 14:29
File No.
FAX:
TOWN OF $OUTHOLD
I~GflAVAY DEPARTMENT
Pe~nic Lane
Peconic, New York 11958
(6~) 765-31140
PAGE 2/
S
APPJ~CATION/PEI~flT FOR HIGI[~WAY EXCAVATION A.ND I~EPAm
]~f'.#T100404~3i
Priat or Tv~
I) K]~Sp.4LN ]KN~- GAS CONifeR. DEPT. - 175 E. OLD COUNTRY RD. - H/C~VILi~I~= NY 11~1
Name ~f A01d~mt Ad~e~
3) ~lnmk Lane - 4'X4' IMImnie on the e/s of ~eu.~.~ ~..~_ 370' s/~ Main Str~t. C~-_-~_=~-~ m .'~.~'_.'._ · ~
Wm'k Deception and l. men(ma (Street Number, lhmlek Crn~ S~reet)
(a) ls constru~ Imamd witMa 75 fe~ af ~lal we~ads: 'Yes
*If yes. other Town p~rmits may b~ r~qMred.
4) Builder's Licensc No. Pl~mb~'s ~ No.
No X
4) Tax Map: ~ , Bilk
7) ~artiug Date: Comple~n Daa~
8) WKk Sc~duW;
tot
Fa~lit~ Klsstalla~bn .............................................................
hcldlll & ~eB~,:~a .........................................................
Part. meat t~lattmem .......................................................
Comule~on Dq~
~) Under which authority Is lhe application made:
:JO) F-4tlmated Co~ofProp~d Wor~ $.
11) Remarks:
FILE No.570 07×13 '04 14:30
FAX:
PgIGE 3/ 5
B. l~c~tlions 18'~ in depth or icss:
0-10~ I-~ = $10.00
I.f. ~ $0.10 = $
B~vadoas 18" ia ~ ~o ~' in d~:
0-100 L£ = $30,00 =
~ Lf, @ $0.3O ='
D. l~eavalions s' in de~h and over:
0-I00 I.f. ~- $5o.oo
Lf. ~ SO.SO =. $
AddiUoaal
Utility Rep~ Excavations @ S l 0.00 = $
No.
Additkmal
NoUec to publW utilities woof mu~ bc provided and anached m ~hi$ applicaUo~ Mior to issuance of
TOTAL CO~T
Au~ ie b~:fay ~anled ~o Ibc Town ~ of
I~YSP.,LN I~N~RGY I)KLI-v~Ry ~n ~
Nme: ~m~it ~q~iteS cec (1) ~ f~m l~m of b~uaac~. No wo~k ~o san witho~; 48 h~r no,c0 ~o d~ ~p~tcrW~; ~ F~i~w~ys.
Pmni; mu~t be syllable ~'
[}-39
Page 2 of 3
7/13/20042;~:32 PM
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CUTCI-I~OU~
PERMIT APPLICATION S~.TCH
VILLAGE
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